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A COMPENDIUM 




EDICAL SCIENCE, 



FIFTY YEARS' EXPERIENCE IN THE ART OF HEALING 



PLAIN AND PRACTICAL TREATISE 



PREVENTION AND CURE OF DISEASE, 



DESIGNED TO ENLIGHTEN THE POPULAR MIND IN THE TRUE ELEMENTARY PRINCIPLES 

OF MEDICINE, AND PROTECT THE READING PUBLIC FROM 

THE MISCHIEFS OF QUACKERY. 



\° 



By SAMUEL K. JENNINGS, M. D. 

Late Professor of Obstetricks, &c, in the Washington University of Baltimore 



TUSKALOOSA, ALA: 

MARMADUKE J. SLADE, PRINTER, 
1847. 






Entered according to the act of Congress, in the year 1847, 

By SAMUEL K. JENNINGS, M. D. 

In the Clerk's Office of the District Court for the Middle District of Alabama. 






DEDICATION 



Authors ask permission, or assume the liberty, to dedicate 
their publications to illustrious patrons, with the hope of de- 
riving additional personal dignity, or of procuring for their 
works a greater number of readers. We frankly acknowledge 
the influence of both these emulations ; and in the spirit of 
becoming courtesy, dedicate the Compend of Medical Sci- 
ence to the Intelligent, the Humane, and the Benevolent, 
of all classes, in our vast community. 

To the Intelligent first, because they will perceive the in- 
tention of the writer is, to introduce his readers to such an 
acquaintance with medical science, as will enable accurate 
observers, and close thinkers, to a very useful extent, to be- 
come, what great physicians, great statesmen, great jurists, 
great agriculturalists, or great merchants, always were, and 
must continue to be, self-taught. 

They will perceive, that our work is intended to show to 
all candid readers, that the art of healing is not necessarily 
beclouded with inexplicable mystery. That the medical phi- 
losopher is not the enemy of his fellow citizens ; nor the in- 
telligent practicer of his profession, a curse to the human fam- 
ily. 

If therefore, we shall succeed in attracting the attention of 
a goodly number of readers of this highly respectable class, 
our emulation to gain worthy personal distinction, will be 
fully gratified. 

Our dedication is made in like manner to the Humane. 
It must have been a source of grief to all who feel a becom- 



DEDICATION. 



ing regard for the welfare of mankind, to contemplate the 
melancholy fact, that men of every grade of intellectual at- 
tainment, are better acquainted with every other concern than 
that of their own health. . The sciences of government, law, 
religion, morals, &c, are studied as subjects of common in- 
terest ; as necessary to a safe, peaceable and respectable pas- 
sage through life, but the knowledge necessary for the preser- 
vation of health, is confided to those whose professional busi- 
ness it is, to visit and prescribe for the sick. This is a de- 
fect in the condition of humanity, that ought to be corrected. 

If we shall have succeeded in making it manifest, that eve- 
ry man may know when he is in danger of being sick, and 
may ward off a threatened attack, or if actually under the 
influence of any ordinary disease, may arrest it in its onset, 
by his own exertion, it must follow, that the cause of human- 
ity will be promoted by our instruction ; and that many of 
our most humane fellow citizens will be numbered with our 
patrons. 

If our sanguine hopes, in respect to these two distinguish- 
ed specifications of our expected patrons shall be realized, 
we are safe in regard of the Benevolent. 

Those excellent ones, whose disposition is to be useful to 
others ; whose happiness requires them to cultivate fraternal 
love to mankind, and who rejoice when occasion offers to do 
them good, will appreciate our confident expectation of un- 
limited patronage from them. 

Let the Intelligent give us their sanction, the Humane 
their approbation, and our success will be secured by the 
voluntary exertions of the Benevolent. And they will col- 
lectively, individually, and most deservedly be entitled to 
the most profound respect of their very obedient, 

THE AUTHOR. 



ADVERTISEMENT 



In view of the probability, that our book may be exten- 
sively read and fall into the hands of many young physicians, 
we conceived the after-thought, of adding the several items 
which constitute the appendix. 

The treatise on prolapsus, &c. may possibly call the atten- 
tion of some of the older members of the medical fraternity, 
and provoke them to renew their acquaintance with a sub- 
ject which so much interests humanity, and which, they 
know, has been too much neglected by the profession. Mr. 
Charles W. Stockton, the gentleman in Philadelphia, who 
has been so long known as the manufacturer of superior por- 
celain teeth, holds a patent for the making and vending the 
pessary described in the treatise, which of course he will 
supply, as there shall be a demand for it. 

The Synoptical Table of Materia Medica, will be found 
convenient for reference, to the student of that subject, at 
the same time, that it presents a very simple and compre- 
hensive view of the therapeutic principles which should re- 
gulate the selection of medicinal substances. 

The abridged treatise on the subject of Toxicology, is ad- 
ded for the same reasons which led the French Institute, in 
their report, to recommend it to the notice of government, ad- 
vising that a copy should be kept for immediate reference, in 
all the public offices, as well as in every private house in the 
kingdom. 



CONTENTS. 



Preface, 17 



PART I. 

Elementary Principles developed and supported by Physio- 
logical and Pathological facts and observations , prepara- 
tory to a proper understanding of the following work. 

CHAPTER I. 

Treats of vitality, as it is apparently inherent in the ani- 
mal fibre ; — as it is modified for special purposes, and man- 
ifest in the organs of sensation ; — and as it is related to 
a more general and transient sensorial influence, and made 
dependent on the circulation of the blood. 

Of sensorial influence as associated with vitality in preserv- 
ing the vital motions and functions of the system ; its ac- 
cumulation under circumstances calculated to produce vio- 
lent disease, and of its deficiency in diseases with prostra- 
tion. 

Of the same influence as it is associated with excitement and 
promptly obedient to stimulants and irritants ; of course 
as being especially concerned in the production of irrita- 
tion and inflammation. 

Of excitants as manifest in the actions and functions of 
the system, in the condition of health and disease. 

Of stimulants and their agency in the production of excite- 



CONTENTS. 



ment, whether natural and healthful or excessive and 
morbid. 
Of vital heat as an agent requiring special medical attention; 
and of artificial heat as affording a means for exerting a vast 
amount of control over incipient disease. 41 

CHAPTER II. 

Details and explains the circumstances developed by an ex- 
periment which may be conveniently and satisfactorily 
made by any one, and shows how important it is, to have 
a due regard to temperature 52 

CHAPTER III. 

Description and explanation of disease, when consequent on 
exposure to cold or inclement weather ; demonstrates what 
disease is, when it is thus suddenly induced in persons 
previously in good health and in healthful climates 55 

CHAPTER IV. 

Explains idiopathic fever, or fever properly so called. The 
most important elements, for the establishment of which 
this work is intended, are brought into view as they exist 
and are exhibited in a case of acute inflammation of the 
lungs;. and the same are proved to be, equally the elements 
which are concerned in the production of a case of inter- 
mitent fever 58 

CHAPTER v. 

Theories of fever — Cullen, Brown, Stokes, Baine, Clanny, 
Clutterbuck, Broussais and Smith, are briefly noticed : 
concluding with what the author considers to be an ap- 
proximation to the true one 71 

CHAPTER VI. 

Demonstrates the philosophical propriety and necessity of 
blood-letting, as the most efficient means of arresting fever 
in its forming state, and the most effectual and trust- 
worthy remedy, if timely and judiciously employed, for 
the cure, when by oversight or neglect it shall have been 
established , .... ,..•.. 81 






CONTENTS. 



CHAPTER VII. 

Additional remarks on blood-letting. The use of the lancet 
superior to leeching, or scarification and cupping j to vomit- 
ing, purging, or sweating . 86 

CHAPTER VIII. 

Prejudices against blood-letting met and corrected 93 

CHAPTER IX. 

Reasons given more extensively wherefore blood-letting is 
preferable to all other depleting remedies 101 

CHAPTER X. 

Continues the subject of blood-letting, describes some of the 
states of the pulse which indicate the propriety of its use, 
presenting important therapeutic instructions, in aid of 
young physicians, to prevent error or abuse in its employ- 
ment 105 

CHAPTER XI. 

Additional remarks on the pulse 114 

CHAPTER XII. 

Directions for feeling the pulse 123 

CHAPTER XIII. 

Considerations forbidding the use of the lancet, or requiring a 
cautious or sparing use of that remedy 128 

CHAPTER XIV. 

The use of blood-letting in cases of pregnancy and parturi- 
tion, 133 

CHAPTER XV. 

Miscellaneous on blood-letting 137 

CHAPTER XVI. 

The various appearances of the blood when set to cool after 
blood-letting 140 

CHAPTER XVII. 

An inquiry respecting the quantity of blood that can be safe- 
ly drawn in any instance of blood-letting, and how often 
it can be safely repeated 150 



10 CONTENTS. 



PART XL 
THERAPEUTICS. 

CHAPTER I. 

Defines the legitimate objects and powers of therapeutics, ad- 
mits the universal concurrence of the recuperative power 
of nature, in effecting the retirement of disease ; whilst it 
exposes the absurdity and danger of committing to nature, 
unaided by art, the disorganizing tendencies of acute dis- 
ease, or of expecting from her the correction of any organic 
mischief, the common result of disease when permitted to 
run its own course 159 

CHAPTER II. 

Explains what is meant by a therapeutic indication : shews 
that a philosophic physician makes up his prescription, con- 
templating some definite effect, either in regard to the 
general system, or some particular organ — disparages noso- 
logical systems of nomenclature, by insisting on the abso- 
lute necessity of being guided by physiology and patholo- 
gy in forming an intention to cure, and refusing to be em- 
barrassed by the name of the disease . . 171 

CHAPTER IV. 

In forming therapeutic intentions, scientific reference must be 
had to the anatomy and physiology of the organ affected 
by disease, and to the diagnostic symptoms, as settled and 
confirmed by pathology 177 

CAAPTER V. 

Considerations in respect to age, temperaments, &c 185 

CHAPTER VI. 

Treats of strength and debility, trades, professions, habits, 
&c &c 200 



CONTENTS. 11 



CHAPTER VII. 

Treats of additional discretions in respect to the causes of dis- 
eases, their seats and degrees of intensity . .212 



PART III. 



CHAPTER I. 

Introductory to Materia Medica 227 

CHAPTER II. 

The therapeutic power and value of medicaments 236 

CHAPTER III. 

Of the surfaces to which medicaments may be applied, and 
through which impressions may be made by medical 
agents 241 

CHAPTER IV. 

On Emetics 254 

CHAPTER V. 

Emetics continued 268 

CHAPTER VI. 

Cathartics 282 

CHAPTER VII. 

Cathartics, continued 295 

CHAPTER VIII. 

Diaphoretics 308 

CHAPTER IX. 

Diaphoretics, continued 322 

CHAPTER X. 

Diaphoretics further continued with rules respecting their 
employment and method of application. ............ 334 



12 CONTENTS. 



CHAPTER XI. 

The Alcoholic Vapor Bath as a diaphoretic, and as the most 
extensively, useful of all general agents 341 

CHAPTER XII. 

Epispastics 362 



PART IV. 



CHAPTER I. 

An anatomical sketch with physiological remarks, introduc- 
tory to the practical treatment of disease 373 

CHAPTER II. 

Fever in its general aspect 381 

CHAPTER III. 

Intermittent fever 385 

CHAPTER IV. 

Congestive fever, .* 388 

CHAPTER V. 

Inflammatory fever 391 

CHAPTER VI. 

Catarrh 395 

CHAPTER VII. 

Bronchitis 398 

CHAPTER VIII. 

Chronic Bronchitis 404 

CHAPTER IX. 

Inflammation of the larynx 407 

CHAPTER X. 

Croup 408 



CONTENTS. 13 

CHAPTER XI. 

Hooping Cough ........ 412 

CHAPTER XII. 

Pneumonia or Inflammation of the Lungs 416 

CHAPTER XIII. 

Pleurisy, 420 

CHAPTER XIV. 

Roseola— Nettle rash 422 

CHAPTER XV. 

Erysipelas, or St. Antony's Fire, , 424 

CHAPTER XVI. 

Scarlet Fever 426 

CHAPTER XVII. 

Measles 430 

CHAPTER XVIII. 

Small Pox, 434 

CHAPTER XIX. 

Mumps 436 

CHAPTER XX. 

Gastritis or Inflammation of the stomach, 437 

CHAPTER XXI. 

Enteritis and peritonitis inflammation of the mucous mem- 
brane of the bowels 439 

CHAPTER XXII. 

Diarrhoea 442 

CHAPTER XXIII. 

Dysentery 444 

CHAPTER XXIV. 

Cholera morbus 447 

CHAPTER XXV. 

Colic, 449 

CHAPTER XXVI. 

Dyspepsia , ; 451 



14 jj CONTENTS. 



CHAPTER XXVII. 

Jaundice , . . 453 

CHAPTER XXVIII. 

Heac-ache. 454 

CHAPTER XXIX. 

Piles, or Haemorrhoids, 456 

CHAPTER XXX. 

Rheumatism 458 

CHAPTER XXXI. 

Chronic Rheumatism and Gout, . . . 461 

CHAPTER XXXII. 

Hoemopthisis, 462 

CHAPTER XXXIII. 

Inflammation of the eye 465 

CHAPTER XXXIV. 

Hydrocephalus, or dropsy of the brain 467 

CHAPTER XXXV. 

Dysmenorrhea, or painful and difficult menstruation,. . .470 

CHAPTER XXXVI. 

Menorrhagia, or immoderate flow of the menses, 471 

CHAPTER XXXVII. 

Cessation of the menses 473 

CHAPTER XXXVIII. 

Chronic Hydrocephalus 474 

CHAPTER XXXIX. 

Amenorrhea 475 

CHAPTER XL. 

Puerperal, or child-bed fever 477 

CHAPTER XLI. 

Phlegmasia alba dolens, or milk leg 482 

CHAPTER XLII. 

Suppression, retention and incontinence of urine, 4S4 



CONTENTS. 15 

CHAPTER XLIII. 

Colic of infants 486 

CHAPTER XLIV. 

Cholera infantum, or summer sickness of children 489 

CHAPTER XLV. 

Tabes Mesenterica, 495 

CHAPTER XLVI. 

Gangrene of the mouth, 497 

CHAPTER XLVII. 

Concluding remarks, 500 



APPENDIX. 



Hydropathy, or Water Cure 503 

A Synoptical Table of Materia Medica, 509 

Descent, Procidentia, Retroversion, and Prolapsus Uteri, . 520 y 

Toxicology — Remedies in cases of poisoning, &c 533 \ 

Accidents- — Apparent death, suspendeded animation, &c. 563 

Medical prescriptions, 578 \f 

A patient receiving the bath, 582 v 

Glossary, 583 

Index, 587 



PREFACE. 



The author having completed a medical work, the funda- 
mental principles of which have been under review for the 
space of forty years, regards it as a duty which he owes to his 
friends and the public, to submit it to their consideration. 
He believes it to be the policy as well as the duty of the pro- 
fession to popularize the science of medicine. The public 
mind needs to be fortified against the flood of domestic and 
foreign impositions, under the name of remedies, which are 
the result of mercenary ignorance, and pernicious to human 
health and life. With this conviction, it is his earnest desire, 
before he closes his labors and his life, to leave to posterity 
his testimony concerning health and disease, prevention and 
cure ; — -subjects to which his reflections have been devoted 
for more than half a century. 

He flatters himself, that h«is junior brethren in the profes- 
sion, will find interest and profit, in perusing the lessons 
which he has learned in the school of experience ; — lessons 
not taught by text books, nor often made intelligible, except 
at the bed side of the sick ; and he hopes, that so far as he 
shall gain access to the community, his work will have a 
tendency to correct many erroneous opinions, and prevent 
much injurious practice ; whilst it will serve to elevate in 
the public estimation, a profession, which, though it often 



IS PREFACE. 



fails to be appreciated and rewarded, by the ignorant and 
thoughtless, is, nevertheless, justly entitled to the homage 
and respect, the affection and confidence, of the intelligent 
and candid, to an extent beyond the claims of any other 
merely human vocation. 

Feeling the high responsibilities of men of our profession, 
more than forty years ago, he entered upon a course of vigi- 
lant observation, determined, if possible, to detect any exist- 
ing error which might obtain in the science of medicine, and 
to make some improvement, however small it might prove 
to be. 

Two whole years were spent, without having acquired, 
any thing worthy of public notice. Not long afterwards,- 
however, he was called to attend a number of cases of fever, 
of unusual type, difficult to manage, attended with symptoms 
of atony of the superficial capillaries, such as called for spe-: 
cial attention to the external surface of the patient. During: 
this service, he found it necessary, in addition to the use o£ 
ordinary rubefacients, to employ the external application of 
artificial heat. In marking the effect of this practice, he 
formed a number of conjectural opinions, which afterwards 
were tested by additional experience, and corrected or estab- 
lished, as facts directed. 

In the years 1806-7, a similar fever prevailed, to an extent 
never before known in that district of country. Great num- 
bers of the sick were intrusted to his management, affording 
ample opportunity for repeating his observations. In the 
course of this labor, his inquiries assumed a more systematic 
form ; and from that period, to a considerable extent, he has 
been guided in his practice, by principles which he then be- 
gan to understand, and which he now holds to be true. 

For the space of forty years, he thinks he has paid more 



PREFACE. 19 

attention to the surfaces of his patients, than has been the 
custom of any other physician of whose practice he has had 
any knowledge ; and has been in habits of making more 
than ordinary use of artificial heat. The steam of boiling 
water at first, often served him a valuable purpose ; when 
the sick could sit erect to receive it. When his patient was 
much enfeebled, he found this to be impracticable. Besides, 
he had learned by repeated experiments made on his' own 
person, and by similar experiments and observations made 
on a great number of patients, that dry heat could be employ- 
ed advantageously, at a degree of temperature which, if made 
by the steams of water, would inevitably scald the patient to 
death ; and that in cases where a lower degree of heat might 
suffice, if steam were used, it universally produced so much 
moisture of the bed clothes and linen, as in a great degree to 
counteract his intention. 

So far as he is informed on the subject, he first ascertained 
that dry heat, made to impinge upon the naked skin, by 
placing the patient, uncovered, near a brisk fire, or by hold- 
ing a shovel of burning coals as near to the place affected as 
it could be borne, if sufficiently repeated, is the most speedy 
and effectual agent for correcting erysipelatous or phlegmo- 
nous inflammation ; the mostim portant auxiliary in the treat- 
ment of an anthrax or an inflamed wound ; and a remedy 
most decisive in treating inflammatory fever. From time to 
time he had tried various devices for the production and ap- 
plication of heat -of high temperature, so as neither to scald 
the patient nor leave him wrapped in wet clothes. The va- 
rious devices were more or less beneficial, according to the 
facility and extent of his approximation to the desired object. 
At length a perfect method of applying dry heat, became to 
him a very great desideratum. Afterwards he had the hap- 



20 PBEFACE. 



piness to hit upon the use of burning alcohol, and finally he 
invented an apparatus for conducting heat so generated, to 
the naked body of his patient 

During the whole course of this pursuit, he had no other 
design than that of improving his own practice. But the fa- 
cility with which he has since been able to manage every 
grade of fever with which he has met, in at least four differ- 
ent States of the Union r has been such, that he cannot recon- 
cile it to his obligations to humanity, to withhold from the 
public the result of his observations. He has therefore pre- 
pared the following treatise, in which the principles and doc- 
trines, the origin of which he has thus- briefly stated, will be 
found so associated and incorporated with some of the most 
important elements of the profession, and so elucidated by 
their practical application to a sufficient number of diseases, 
as to make his design intelligible. 

By the employment of the apparatus, contrived as above 
stated, he soon learned that* heat so generated and applied r 
with very little, and sometimes with no other aid, is effectu- 
al for correcting predisposition to disease j that by the same 
method, recent disease, when actually formed, is cured in 
the same decisive way ,- that the treatment thus far requires 
no considerable part of skill r but the necessary decision ; no 
caution, but such as common sense will dictate ; and that in 
the hands of physicians it places within the reach of the heal- 
ing art, many cases of disease which for ages have been a re- 
proach to the profession. To extend the knowledge of these 
facts, he made application to the patent office of the United 
States, and obtained a patent. 

As the first and most promising step for bringing it before 
the public, he determined to introduce it into the army of 
the United States, then at war with Great Britain, 



PREFACE* 21 



Having the advantage of a personal acquaintance with 
the Hon. Thomas Gholson, a member of Congress, he for- 
warded to him a letter, signifying the beneficial effect it 
would have, in ithe treatment of disease as incident to the 
army. 

Doctor James Tilton, physician and surgeon general of the 
armies of the United States, happened to lodge in the same 
house with Mr. Gholson, and was made acquainted with the 
author's views. In a few days the physician general obtain- 
ed permission from the honorable secretary of war, and he 
was invited to the seat of government. On his arrival, he 
had the satisfaction to find that preparatory measures w t ere 
already in train for the accomplishment of his wishes. The 
final arrangement and result of the proceeding, will be seen 
in the sequel. 

Washington City, April 7, 1814. 
Dear Sir — Conformably to the orders of the secretary of 
, war, you will be pleased to accompany doctor Adam Hays f 
an hospital surgeon, to Norfolk, in Virginia, and communi- 
cate to him and the surgeons generally of that post, not only 
the principles of your newly invented bath, but the method 
of application ; taking care not only to show the cases in 
which it may be applied with advantage, with the manner, 
duration, &c, but especially to guard them against the mis- 
application, so as not to bring an useful remedy into dis- 
credit. 

Agreeably to the secretary's order, your account for ex- 
penses, &c, may be presented at any time. 
«I am, dear sir, very respectfully, 

Your most obedient servant. 

James Tilton, P. S. G. 

Norfolk, May 5, 1814 
This may certify, that in obedience to an order of the 
honorable secretary of war, and in conformity to the instruc- 



22 PREFACE. 



tions of the physician and surgeon general of the United 
States. Dr. Sanrl K. Jennings has accompanied me at the post ' 
6f Norfolk. Virginia, and satisfactorily demonstrated "to me 
the principles and mode of making the application of his 
newly invented method of curing disease in a summary way,. 
by means of his hot bath. 

A. Hats. Hospital Surgeon, 

Wilmington. (Delaware.) July 16, 1814. 

Dear Sir — Agreeably to your request, I have no hesitation 
in giving you my sense of the utility of your newly invent- 
ed hot bath, in the cure of diseases. I can only speak in 
general terms on a subject so novel; and, perhaps, the best 
method I can take for communicating my thoughts and re- 
flections on the subject, is, by recounting the me^ures taken 
by the hospital department for the investigation of its use- 
fulness. 

By a special order from the secretary of war. I was 
directed to make the necessary arrangements for your admis- 
sion to the hospital at Norfolk. By the same order, I was 
directed to send Dr. Hays, an hospital surgeon of great res- 
pectability, to assist and be witness at the experiments. The 
doctor reported favorably, and in that correct manner which 
gratified the secretary of war, as well as myself. He par- 
ticularly recommends it in regimental practice, "frorn the op- 
portunity it affords of meeting disease in its early stages. ; ' He 
recommends it in fevers, languid excitement of the surface, 
and diseases produced by suppressed perspiration. The doc- 
tor made experiments on about thirty cases, very much to 
his satisfaction, but has not exhausted the subject. 

I have seen the bath applied in a few instances, and have 
had it applied to my own person. The ease and facility of 
the application, and the delightful sensations it affords, are 
greatly in favor of its general use. And when we consider 
the nervous and sensitive quality of the skin, and the impor- 
tance of this emunctory, a flood of argument must arise, for 
the application of remedies to the surface of the body. 
In the promised edition of your explanations, &c. ? besides- 



PREFACE. 23 



the theory and direction for correct application, permit me to 
request, that you will, by every possible precaution, guard us 
against the wrong application of so important a remedy. 
With great respect, I am, dear sir, 

Your friend and humble servant, 

James Tilton, P. S. G. 
Doctor S. K. Jennings. 

Having performed this service, the author determined on 
a visit to Philadelphia and New York. With this intention 
he addressed a note to the President of the United States, 
and obtained the following letter in duplicate — the one copy 
addressed to Dr. Physic, the other to Dr. Samuel L. Mitchell : 

Washington City, August, 1814. 
Dear Sir — Dr. Jennings has a medical invention, in the 
value of which he feels so much confidence, that he is anxious 
to present it to the consideration of the most enlightened 
of the profession. Although a departure in some measure 
from an established rule, I cannot refuse a line which may 
promote an opportunity for the explanations by which he 
wishes his invention to be tested. His benevolent character 
is a further apology for the liberty I take. 

Accept assurances of my great esteem and friendly respect. 

James Madison. 
Dr. Physic. 

Doctor Physic was in ill health, and unable to attend to 
the practice. He favored the author with an interview, how- 
ever, and spoke very favorably of his invention. 

Dr. Mitchell, without having received his letter, and with- 
out solicitation, enclosed under cover to the physician gene- 
ral the following : 

Neio York, March 27, 1815. 
To Dr. Jennings : 

I this day, excellent sir, wrote to the physician general of 
the United States, my opinion of your mode of applying heat 



PREFACE. 



to the external surface of the human body ; and on Portio's 
method of directing its action upon the stomach and internal 
parts. 

I have caused several experiments to be made with the al- 
coholic vapor, on the patients of the New York hospital. 
I am inclined to believe it is an efficacious and valuable reme- 
dy. It is remarkably neat. Nothing can be more handy. 
And really it in some sort enables you to place your patient 
beyond the climates, where snow and frost exercise their 
chilling influence, to the regions where solar warmth is more 
uniform and elevated. 

It is a most important part of your heated air, that it is free 
from all smoke, soot and ashes. 

I have considered the spirituous decomposition chemically. 
I have examined the metallic apparatus mechanically. And 
I have witnessed the action of the rarified vapors re medially. 

Considering a torpor of the skin to be a cause or accompa- 
niment of many diseases, and that heat is the best of all ex- 
citants, I am well satisfied that your method of applying calo- 
ric to stimulate the cuticular surface, is happily calculated to 
give relief in such cases j and produce extensive advantages 
to the sick and disabled, in many other maladies. 

Samuel L. Mitchell.* 

About six months after the receipt of the above highly 
satisfactory letter, Dr. Mitchell again honored him with the 
following most definite testimony : 

New York, 29th October, 1815. 
Dr. Samuel K. Jennings : 

Dear Sir— Since I wrote to you and General Tilton about 
the vapor bath, I have had many opportunities of trying its 
practical efficacy. I am more and more satisfied with the 
value of the remedy. It is so neat, so cheap, so handy, and 
so within the reach of every body, that it surpasses every 
thing with which I am acquainted, for applying caloric to 
the external surface of the human body. It is so capable of 

* Dr. Mitchell was the very learned Senator of the City of New York. 



PREFACE. 25 



conveying heat, so susceptible of a higher or lower tempera- 
ture, and withall so well adapted to a longer or shorter con- 
tinuance, that its power to be beneficial is considerably en- 
larged. 

But above all, the caloric may be directed to a part of the 
body, or to the whole body, to a robust person or to one in 
the lowest debility, to an adult, or to an infant, with so much 
ease ancft>enefit, that I really consider it one of the most hap- 
py expedients that a practitioner can employ. 

For chills, torpors, and that apathy and langour of the cu- 
ticular surface, so often the forerunner or companion of fevers, 
it is preferrable to any other mode of applying heat. The 
warm bath, warm fomentations, and the vapors of hot water 
are very inferior to it. 

The patients in our hospital are exceedingly pleased with 
it, and for myself, I explain it, I order it, and I recommend it. 

Accept the assurances of my high esteem and regard, 

Samuel L. Mitchell. 

Woodstock, (Vt.) February 20, 1816. 

Dear Sir — I have not the pleasuse of a personal acquain- 
tance with you, which might be agreeable ; but I have be- 
come acquainted with your writings and^ -improvements in 
the medical department, by the politeness of Mr. Strong, the 
former representative from this district. He sent me your 
apparatus for conveying the heat of burning alcohol to the 
bodies of the diseased, for which I feel very thankful to him 
and yourself. The very first reflection on the subject car- 
ried conviction to my mind of its utility, and I could but be 
astonished, that the use of it had never occurred to me be- 
fore, considering I have been so intent on the subject of ap- 
plying heat to the surface, for a series of years. I have made 
various trials of it, in different diseases, and find it a very 
valuable improvement. 

At the time it was presented to me, I was engaged in writ- 
ing on the epidemic diseases of this State, viz : in the sum- 
mer and autumn of 1814. I have made favorable mention 
of your improvement in several places in the work, as a duty 



26 PREFACE. 



I owed to society ; and my acknowledgements of gratitude I 
now tender you. 

The work I have alluded to. was printed last summer, at 
Boston, containing four hundred and twenty octavo pages. 
It is entitled, u Sketches of Epidemic Diseases in the State 
of Vermont, from its first settlement to the year 181 5 : with 
a consideration of their causes, phenomena; and treatment : 
to which are added, remarks on pulmonary consumptiAs."" cVc. 

I was astonished to discover from your writings, the simi- 
larity of object and result, from different trains of reflection 
and investigation, and in remote parts of the union. Per- 
haps I am going too far in saying very different modes of in- 
vestigation, they seemed in many respects similar. 

It would indeed, be very desirable to me. if your apparatus 
could be circulated in this quarter. 

Dear sir. with wishes for your prosperity and happiness. 
I am with due respect. 

Your ob't and very humble servant; 

Joseph A. Gallup. K. D. 

The following is from Dr. Thacher. a very eminent physi- 
cian of Plymouth; Massachusetts; who is the author of a 
work, entitled the •" American New Dispensatory.'' as also 
of another, " Observations on Hydrophobia.'' both of which 
have done him honor. He was then engaged in the publi- 
cation of a work entitled "American Domestic Medicine." 
which had much excited public expectation, and proved to 
be a very respectable production. 

Plymouth. (Mass.) March. 17. 1S16. 
Sir — Having been apprized that you have invented a meth- 
od of communicating heat by means of a spirituous vapor 
bath. I take the liberty of addressing you on the subject, and 
the enclosed prospectus will explain my views. I am solici- 
tous to make my intended publication a medium of every 
improvement and discovery relative to practical medicine: 
and if consistent with vour arransements. to favor me with 



PREFACE. '27 



a short sketch of the principles and utility of your method, 
within a few weeks, to be inserted in the appendix of my 
work ; it will be very gratefully received, as it may premote 
the views of us both, and at the same time prove highly ad- 
vantageous to the public. 

From report, I am of opinion that your invention is ex- 
tremely well calculated for the purpose intended, and that it 
ought to be more generally known in this part of the coun- 
try. I have not been fortunate enough to meet with either 
your publication or apparatus, and if any arrangement could 
be made for the purpose, it might be in my power to extend 
the employment of it in this vicinity. 
I am, respectfully, 

Your obedient servant, 

James Thacher. 
Dr. $. Jennings. 

A sketch of the author's views was forwarded and publish- 
ed in the appendix of the American Domestic Medicine. 

Three of his fellow citizens, very respectable physicians, 
unsolicited, favored him with the following letters : 

Lynchburg, March 1, 1814. 

Dear Sir — I take a pleasure in informing you, that for the 
last five or six weeks, I have applied your hot bath with evi- 
dent good effect, on a great number of my patients — indeed 
I think it a most valuable acquisition to the .catalogue of 
medical agents. • The principles upon which it is used, only 
want to be known, to bring it into esteem and general use. 
Out of the many cases to which I applied it, for brevity's sake, 
1 will select the following : 

1. A case of hepatic state of fever.* — This was a lady, 
who, before I was called on, had been treated in the usual 
way, by her attending physicians — bleeding, cathartics, a 
blister on the part affected, antimonial mixtures, &c. had 
been tried. I found her with cold extremities and surface ; 
fixed pain about the region of the liver, attended with cough, 

* Dr. Cabell was a pupil of Dr. Rush. 



2S 



PREFACE. 



general debility, and a feeble pulse. By the use of your bath, 
and a few small doses of calomel, with pectoral febrifuges, she 
was soon restored to perfect health. 

2. A case of inflammation of the stomach and bowels. — It 
was a desperate one. This too was a female case, whom I 
found on visiting her, with cold extremities and surface, vio- 
lent pain about, the region of the stomach and upper bowels, 
with langour, faintness, and scarcely a perceiveable pulse in 
the radial artery. In this situation she continued nearly two 
days, notwithstanding cordials, opiates and cathartics, were 
administered, and a large blister was drawn upon the region 
of the stomach, and two upon the extremities. No passage 
could be procured, or general excitement raised on the sur- 
face. I applied your bath, and continued its application till 
a general diaphoresis was produced, and kept up for some 
hours, soon after which a passage was effected by ordinary 
means. I then used it periodically, so as to keep up the ex- 
citement on the surface till the patient was relieved. I con- 
fidently believe this woman would have died, had it not been 
for the aid of your bath. 

Yours, respectfully, 

John I. Cabell, M. D. 

Ly?ichbnrg, April 3, 1814. 
Dear Sir — Having used your bath with decisive advantage 
to several patients, I cannot but regret that any one should 
so far mistake" your object as to suppose that you consider it 
a specific. Having for four years past received frequent com- 
munications from you, explanatory of your experiments and 
observations upon the surface, and of the probable benefits 
to be derived from a more perfect method of applying heat, 
I am in duty bound to offer you my little influence in oppo- 
sition to such illiberal insinuation. I, know that your inven- 
tion is the result of much philosophical inquiry, and promises 
great good to the community, as one powerful auxiliary in the 
cure of disease. And I know, moreover, that it may be so 
used, as, in many instances, pleasantly to supersede the use 
of other agents, which are loathsome in their administration, 



PREFACE. 29 



and, more or less, deleterious in their effects upon the system. 
Permit me to narrate the circumstances which attended a 
single case, which I treated upon your principles. It was an 
instance of a most painful dismenorrhagia, protracted to the 
length of five days, with frequent faintings,, and continued 
watchfulness. On the fith day she became perfectly deliri- 
ous, with a pulse beating one hundred and twenty in the 
minute, and her extremities cold. At this stage I was called 
in. I immediately exhibited an anodyne, which was reject- 
ed. An attempt was then made to compose her stomach 
with cordials, intended to be preparatory to the trial of an- 
other opiate. The attempt proved abortive. By this time 
three hours had passed away in painful anxiety, every mo- 
ment hoping to see the stomach prepared to receive such 
agents as appeared to be necessary. Under these circum- 
stances, I most willingly availed myself of the genial heat of 
your bath j first applying it to her lower extremities j and so 
soon as her feet were well warmed, removing it* to her 
stomach, where its powers were concentrated, until a general 
but moderate diaphoresis was induced. Before the operation 
was ended, the delirium went off, and the patient dropped 
into a pleasant sleep, and rested composedly for the space of 
two hours. 

An opiate was then exhibited, which was retained by the 
stomach. Medicines, such as are ordinarily used in these 
cases, were afterwards advised, and the bath was repeated 
the following evening. In ten minutes after the repetition 
of the bath, the patient broke out uncommonly thick with 
the measles. 

I was informed that she had been exposed to the cold for 
twelve hours, about the time she expected to be in delicate 
health, and the immediate effect was such as I have describ- 
ed. Till convinced by the fact, her friends were fully of 
opinion that she had had the measles years ago. It is worthy 
of notice, that so completely was the surface abandoned by 
the excitement, so extensively was it locked up in the system, 
that she had none of the ordinary appearances which usher 
in the measles. Neither high fever, cough, nor sore throat 



30 PREFACE. 

attended her case. There was indeed, an alarming deficien- 
cy of animal heat — and 1 am confident, without the influ- 
ence of artificial heat, to that extent, and with that decision 
which your bath only could have furnished, this patient would 
have died, and no one would have suspected the true nature 
of the disease by which her dissolution would have been ef- 
fected. 

I am yours, respectfully, 

Gustavus A. Rose, M. D. 
P. S. — It is a certain fact, that the sleep was induced ex- 
clusively by the bath. The first anodyne dose was given in 
form of a pill, which was seen when it was thrown up. 

G. A. Rose. 
Doctor S. K. Jennings. 

♦ 

Lynchburg, July 17th, 1815. 

Dear Sir — Every day gives fresh proofs of the value of 
your bath. In two violent cases of spasmodic croup, I effect- 
ed a cure with it in twenty minutes. Calomel was exhibit- 
ed after the spasm was overcome. 

Mr. S. Barnard, after working steadily during a warm day, 
was seized at night with severe spasm ; his face was quite 
distorted when I got to him, and he had lost the use of his 
superior and inferior extremities ; the muscles concerned in 
respiration, were so far deprived of power, that he breathed 
with difficulty, and those of the tongue so severely paralyzed, 
that he could scarcely make himself understood. The bath 
was applied, and it relieved him in a few minutes. He took 
a cathartic that evening, and was quite well the next day, 
except the soreness which was consequent upon the violent 
contraction of the muscles. 

I have applied the bath in the late epidemic, (Peripneu- 
monia Typhoides;) in most cases respiration was immediate- 
ly relieved by it. Where suffocation was threatened from a 
swelling of the throat, the bath was of great benefit. It was 
associated, however, with bleeding, blistering and cathartics. 
By warming the surface, the determination was changed, 
and in all slighter affections, the engorgement of the lungs 



PREFACE. 31 



readily overcome ; but in the more violent cases, it was ne- 
cessary to keep the bath in operation until quite a tense ac- 
tion was induced, after which the lancet could be used with 
safety, and the lungs more effectually relieved. Where the 
excitement had been equalized by the use of the bath, the 
balance was maintained by blistering with a peculiar facility 
and in many cases blisters were not necessary. In all these 
cases the bath was used as an auxiliary, together with other 
medicines. Among others, I also was seized with this dis- 
ease last fall, and in the course of an hour respiration be- 
came so difficult, that I began to apprehend very serious con- 
sequences ; my pulse was small, feeble and frequent, and my 
veins sunk. I went to bed, but could lie only on my back ; 
the bath with two cups was put in operation at my feet, and 
kept there fo? nearly an hour. By this time my pulse be^ 
came full and bold, I breathed with comparative ease, and 
could lie on either side. The bath was now changed, and 
Ihe heat directed to the affected side, for thirty minutes, 
when my pulse became tense : I then drew ten or twelve 
ounces of blood, and after remaining an hour longer in bed, 
arose, put on dry linen, and went about my ordinary business, 
suffering not the least inconvenience, except from a slight 
stitch in my side. 

The bath has been used by me in some cases of puerperal 
fever. I find that stimulants may be administered with great- 
er safety when it is applied ; and in some other forms of dis-i 
ease, there appears to be less hazard in the exhibition of opi-' 
ates, as they are rendered more diffusible by the bath, and 
consequently less disposed to seek an improper determina- 
tion. 

Wishing that the powers of this useful invention may be 
more generally known, 

I remain your ob't 

William Owens, M. D. 
Doctor $. K. Jennings. 

The following letters were sent to the author 3 by Doctor 



32 PREFACE* 

Sargent, a respectable physician, and a minister of the Metho- 
dist Episcopal Crunch of Philadelphia: 

Philadelphia, August 10, 1814. 
Dear Sir— On Sunday evening last. I was called to visit a 
lady at the corner of Market and Eleventh streets, who on 
Friday evening previous had been violently attacked with 
asthma, and when I saw her, was still laboring under much 
difficulty of breathing with her face flushed, and great pain 
in the head, and right side. I immediately applied your 
patent bath, and in about twenty minutes produced a very- 
free perspiration, with an immediate mitigation of the dis- 
tressing svmptoms. After this application, I gave a teaspoon- 
ful of elixT paragoric, and no other medicine: expecting how- 
ever, that she might possibly require some btoeding in the 
morning. Indeed I would then have bled, but wished to 
give the bath the fullest trial, to see what its effects would 
be. without other aid. I saw this lady at 6 o'clock the next 
morning, and was much pleased to find her entirely relieved, 
insomuch, that I thought any thing further unnecessary, ex- 
cept a little of the brown mixture as an expectorant. The 
lady remarked with surprise that the pain in the side had also 
left' her. which, in every previous attack, had uniformly re- 
mained some days after all the other symptoms had com- 
pletely subsided. 

Yours with esteem, &c. 

Thomas Saegext, M. D. 

Dr. S. K. Jennings. 

Philadelphia. August 3 r 1S15. 
Dear Sir— A very respectable lady, of the Society of Friends 
pronounced by her physician in Jersey, to be in the last 
stao-e of pulmonary consumption, came here to place herself 
under the care of Dr. Wistar. But hearing of me, and ot 
your bath, placed herself under my care. I fully expected 
she would not survive one month ; such were her symptoms 
and appearance, especially, when she informed me, that she 
had lost three sisters and two brothers in that disease. Not- 



PREFACE. 33 



withstanding all these discouraging circumstances, I com- 
menced, and by day gave her the muriatic acid, as you advis- 
ed, and by night Jennings' Vapor Bath ; and by the blessing 
of God, in six weeks sent her home, not barely recovering, 
but quite well. 

The lady to whom I gave the bath in August, 10th, while 
you were here, in an attack of asthma, has had no return of 
it since. This I think very singular, as she had been sub- 
ject to returns of the complaint every three and four weeks, 
for six or seven years past ; she has also recovered her flesh 
and general health, to all appearance. I lately made the ap- 
plication to a Mr. Davies in Market street, who for more than 
a year past, has had violent spasmodic affections of the kid- 
neys. In a few hours after the application, he discharged a 
small stone, about the size of a pea, which, I would judge 
must have been formed in the pelvis of one of the kidnies. 
Yours in love, $*c 

Thomas Sargent, M. D. 
Doctor $. K. Jennings. 

The following letter is introduced in this place, on ac- 
count of the variety of the cases, and the efficiency of the 
remedy in the hands of a very respectable citizen of Virginia,, 
who had no pretensions to medical science. 

Fauquier Court House, August 2d, 1815. 

Dear Sir — If you could have furnished me with the bath 
and explanatory pamphlets, in my opinion I could have dis- 
posed of from fifty to one hundred since last fall. I have 
made use of it constantly in my family for ten months, in 
the commencement of all colds, and in almost every instance 
have found it very beneficial indeed. Most diseases seem 
to be produced by cold, and on immediate application it 
checks the disorder in an agreeable and pleasant manner. 

I am myself very subject to taking cold, and have applied 
it constantly, and derived great benefit. I am the more pleas- 
ed with it on account of the pleasant sensation it produces^ 
3 



34 PREFACE. 



contrary to the expectation of a person never having experi- 
enced it. 

1 have found it to produce wonders in my own family in 
the rheumatism, and in the bilious fever ; and in the cholic, 
among some of my neighbors — where they could get relief 
no other way. Some seemed to be in such an agony, as if 
they must die, and when the bath was applied, and a pro- 
fuse perspiration was produced, they were immediately re- 
lieved. 

I attended a neighbor not long since, who was suddenly 
taken with a violent pain across his breast and shoulders, so 
that he could not turn in his bed. I applied the bath locally, 
extending and continuing the heat until he was very warm 
and wet. He was relieved. In fact, in a few hours was out 
of bed" and in health. Really such is my opinion of this in- 
vention, that I would not take five hundred dollars for the 
bath, could I not get another. Some weeks past I had a vio- 
lent cold, was so hoarse and had such a cough that I could 
scarely talk. I dreaded the application of the heat on ac- 
count of the very warm weather ; not having tried it in the 
summer till then. But to my surprise it was agreeable, and 
the hoarseness was removed immediately. The cold broke, 
I discharged the gathering mucus and was shortly relieved. 
It certainly would be a great benefit to the world, was its 
value known, and it was brought into general use. 
I am, with great respect, 

Your obedient servant, 

Thad's Norris. 



James Mann, M. D. Hospital Surgeon of the army of the 
United States, in a work published by him in IS 16, (page 

182, ) says: 

" Experience has demonstrated, that the vapor bath of 
Doctor Jennings is superior to any mode of removing rheu- 
matism. <* 

" Without detailing that train of reasoning by which he 



PREFACE. 35 

supports a theory, somewhat peculiar to himself, of the caus- 
es of diseases, and their most appropriate mode of treatment, 
especially when supervening with most morbid symptoms, 
we shall merely say ; that diseases attended with general 
coldness of the body, local or more universal pain through 
the system, torpor and mental derangement, in which the 
patient, if not immediately relieved, expires within two or 
three days, often within the first twenty-four hours, have 
raged in these regions. The insuperable coldness and tor- 
por which exists in such cases, have led scientific physicians 
to restore heat to the body by artificial means. For this 
purpose, the warm water bath, billets of wood heated, hot 
ashes, bladders filled with hot water, &c, according to the 
fancy of the' prescribing physician, have been applied, in va- 
rious ways, to the body. In some instances, these warm 
and hot applications have been followed with success ; while 
in others, they have failed; not because the intention of the 
application was incorrect, but because it was not completely 
fulfilled. The moisture which is attached to the body and 
the surrounding clothes, frequently counteracts all the bene- 
fit derived from the heat communicated, by favoring its 
speedy evaporation from the body ; consequently, the patient, 
in a short period, is found as cold and as torpid as he was 
previous to the employment of those heated applications. 
In these cases internal stimulants, such as ardent spirits, 
have been resorted to, with effects more frequently danger- 
ous than salutary. They induced higher degrees of excite- 
ment in the larger internal vessels, and in some important 
viscus already in a gorged state, without being capable of 
extending their influence to the extreme vessels of the skin. 

" Dr. Jennings' vapor bath remedies the evils which are 
necessarily connected with the usual application of heat ; as 
its effects are more general, and are diffused throughout the 
system, establishing a more equable excitement, without the 
hazard of exhaustion which follows the employment of a 
water bath heat in consequence of its sudden evaporation. 

" A full knowledge of his treatment cannot be obtained, 



36 PREFACE. 

except by reading the whole work, which is scientific and 
incomparable." 

At the close of 1820, the author having exerted all his in- 
fluence, and devoted five years to the accomplishment of his 
purpose — that of making known to the community the value 
- of his discovery, he discontinued further effort, in the hope, 
that it would make its way without additional pains. 

Having been disappointed in this hope, in the year 1843, 
he made application to the Congress of the United States, 
and the following act was passed in his favor : 

An Act for the relief of Samuel K. Jennings. 

Sec. 1. Be it enacted, by the Senate and House of Repre- 
sentatives of the United Stores of America in Congress as- 
sembled, That the Commissioner of Patents be, and he is 
hereby directed to renew, for the period of fourteen years, 
the letters patent granted to Samuel K. Jennings, of the city 
of Baltimore, in the year one thousand eight hundred and 
fourteen, for an apparatus for the speedy generation and con- 
venient, prompt and agreeable application of heat to the hu- 
man system ,* and that he embrace in said renewal of letters 
patent, the improvement subsequently made by said Jennings 
m its mode of application ; subject however, to the rules and 
usages of the patent office, and all its provisions, except as 
aforesaid, of the act entitled "an act to promote the progress 
of the useful arts/*' and all acts in addition and ernandations 
thereto. 

Approved, March 3d, 1843. 

In conformity, therefore, with the directions in the said 
act contained, I, Edmund Burke, Commissioner of Patents, 
do hereby certify, that the patent therein described, is by 
the said act, renewed to Samuel K. Jennings, for the term of 
fourteen years, from and after the third day of March, one 
thousand eight hundred and forty-three. 

In testimony whereof, I have caused the seal of the Patent 
Office to be hereunto affixed, this fourth day of April, 1S44. 

Ediniund Burke, 
Com mission er of Paten ts. 



PREFACE. 37 

His motives and purposes remain the same. He has ob- 
tained a renewal of the patent, to secure to himself a reason- 
able compensation for the labor, time and expense, to which 
the work has subjected him • and relies upon the justice and 
liberality of his fellow citizens, for himself; and upon their 
humanity and benevolence, for the general relief and bene- 
fit of the sick. 

THE AUTHOR, 



A COMPENDIUM 



MEDICAL SCIENCE 



PART I. 



momentary Principles, developed and supported by Physiological and 

Pathological facts and observations, preparatory to a proper 

understanding of the following work. 



CHAPTER L 

VITALITY, SENSORIAL INFLUENCE, STIMULI, EXCITEMENT, 

&c. &c. 

M. Rieherand defines life to be, " organism in action."* 

Action, as exhibited in organic life, is an effect. To pro- 
duce the effect, the organs mast be endowed with an apti- 
tude to be excited by appropriate agencies or influences, and 
these agencies or influences must be present, and make the 
requisite impression. 

This aptitude to be excited, for the sake of intended dis- 
tinctions, we will denominate vitality. By vitality, the sev- 
eral organs are made capable of performing the continuous 
and combined actions, required in organization. It must 
therefore receive incessant support ; this support is furnished 
through the great nervous centres ; and these are sustained 
by the circulating blood. Hence, vitality, though apparent- 
ly inherent in the fibre, soon becomes extinct, if it be depriv- 
ed of the circulation. 

The circulation of the blood, so indispensable for the pre- 

* Leibig's idea of vital force, vis vitse, or vitality, is, that it is a " force in 
a state of rest." 



42 VITALITY, SENSORIAL INFLUENCE, ETC. 

serration of vitality, is effected and sustained, by concurring 
influences, which proceed from the sympathetic nerves and 
ganglia, and from the sensorium commune ; those from the 
sympathetic sources, presiding over the organism and func- 
tions of the viscera ; those from the sensorium commune, 
presiding over the entire organization. 

These influences, being incessantly produced, are manifest 
under various aspects. They are manifest in maintaining 
vitality ; in their effects on the functions ; in excitement. 

Vitality is modified by appropriate adaptations to the differ- 
ent structures, and their respective functions ; so that the or- 
gans are prepared to correspond with the influences issuing 
frOm their nervous centres respectively. 

Hence, each of the organs is dependent for the preserva- 
tion of its vitality and of its organic motions and func- 
tions, on its connection with its own nervous centre — and 
the whole of them are adjusted in harmonious combina- 
tion, and placed under a general influence, constituting them 
one organization. 

This general influence may be denominated sensorial or 
nervous power. 

For the purpose of elucidation, we invite attention to the 
conspicuous organs of sensation. 

The eye is endowed with vitality, in a manner peculiar to 
its structure or organism, making it susceptible of impres- 
sions, which we refer to the rays of light. When such an 
impression is made on the retina, and is sustained and reg- 
ulated by the requisite sensorial influence, there is furnished 
an occasion for the exercise of the function of sight. 

The ear, by its peculiar organism, consonant vitality, and 
accompanying sensorial influence, is made susceptible of those 
vibratory impressions, which furnish occasions for the exer- 
cise of the function of hearing. 

The schneiderian membrane, in like manner, is made sus- 
ceptible of the impressions which furnish occasions for the 
exercise of the function of smelling. 



VITALITY, SENSORIAL INFLUENCE, ETC. 43 

The tongue and palate, of those, which furnish occasions 
for the exercise of taste, in all the various distinctions of that 
function. 

And the skin, of the diversified impressions, denominated 
heat and cold, soft and solid, rough and smooth, wet and dry ; 
in a manner peculiar to itself, furnishing occasion for the ex- 
ercise of the function of feeling, in its various capacities. 

Similar organic structure and sensorial correspondence, no 
doubt obtain, in respect of every important organ throughout 
the whole system j the sensorium commune,* &c, the sym- 
pathetic nerve and ganglia ; the heart, the lungs ; the stomach 
and smaller intentines ; the liver, spleen, pancreas, kidneys, 
&c. &c. ♦ 

But these references to the organs of sensation, &c. do not 
furnish notices of the sensorial influence in its co-operation 
with vitality, and producing the results which more particu- 
larly claim the attention of the physician. A sketch of it, 
as it is manifest in the organs and functions of sensation, &c. 
is submitted, with intention to exhibit one view of this diffi- 
cult subject, in a light so clear, that it cannot readily be mis- 
apprehended. 

The main object to be accomplished, is, to prepare Jhe 
reader to form a correct estimate of the sufficiency or insuffi- 
ciency of the current supplies of it, for the preservation of 
the vital motions and functions of the whole system, in view 
of that harmonious regularity, which is health ; to perceive 
how great its power in instances of violent or morbidly di- 
rected action, when any organ is threatened with irritation or 
lesion,! — as also, what the degree of diminution, when the 
system may languish because of a deficient generation of it, 
in an instance of exhaustion.^ 

* Sensorium commune, the anatomical name given to the nervous struc- 
tures which have their centre in the brain and spinal cord. 

f Lesion — Disturbed action, accompanied with injury done to the struc- 
ture of parts. 

X By exhaustion here, is meant the state of the system when worn down 
by disease. 



44 VITALITY, SENSORIAL INFLUENCE, ETC. 

The intended explanations, make it necessary to present 
the sensorial influence in association with excitement, and to 
consider the relation which obtains between them. 

The heart, arteries, veins, lymphatics, glands, secretory 
vessels, &c, by their respective structures and inherent vi- 
tality, are prepared to correspond, each with its own appro- 
priate sensorial influence, so as to perform its own peculiar 
organic action and function. By this provision, blood and 
lymph are elaborated and circulated ; the various secretions 
and absorptions are performed, and the different excrements 
are eliminated. All these organic actions and functions, 
maintained for purposes essential to animal existence, are 
embraced in the comprehensive term, excitement, f 

This view of excitement implies an incessant revenue of 
influences, inasmuch as every instance of action or motion, 
reports the arrival of the exciting influence and its evanes- 
cence or departure. Hence it is obvious, that the volume 
of influence in any instance under medical consideration, is 
estimated by the degree or force of the excitement. 

It is commonly admitted, that the influences to which we 
refer, are generated and sustained by the brain and nerves. 

It is not necessary to the intended explanations, to deter- 
mine, whether the great nervous centres are to be consider- 
ed as so many glands of superior importance, whose func- 
tions are to secrete and through the nerves to diffuse this in- 
fluence to its various destinations ; or whether they may not 
be organs, whose effects resemble electric, or galvanic appa- 
ratus, and in a manner, sui generis, collect and diffuse it ; — 
or whether it be the result of some other provision. By what- 
soever means it is accomplished, the volume furnished in any 
given time, by any particular system, must depend on the 
existing state of health, and be liable to vary with the changes 

f All of these functional actions are instituted and maintained in a similar 
way, consequently, each action is an instance of excitement 



VITALITY, SENSORIAL INFLUENCE, ETC. 45 

which health may undergo; and like the other phenomena 
of animal life, be sustained by the blood-making organs. 

In perfect health, the supply will be adequate to the sup- 
port of the organs and functions essential to the preservation 
of the system ; and also to any temperate expenditure, in 
thinking, .laboring, &c* If, however, such expenditure 
should much exceed habitual boundaries, sleep becomes ne- 
cessary to repair the effect of this excess. 

In sleep, vision, attentive hearing, muscular exertion and 
exhausting thought, are suspended, and by this suspension a 
proportionate saving of sensorial power is obtained. Sleep 
is therefore truly said to be " tired nature's sweet restorer." 
Inasmuch as the organic motions, essential to the preserva- 
tion of the system, are necessarily incessant, and to be health- 
ful, must be equably maintained, a considerable diminution 
in the production of sensorial influence, must not only abridge 
the ability to labor, study, &c. but the resources on which 
depend the preservation of the vitality of the organs, may be 
very seriously affected. 

We then have two correlative positions — 

1. The excitement will be exalted above the natural de- 
gree of strength, if at any time, the sensorial influence be 
generated in greater than ordinary volume. 

2. The excitement must necessarily be depressed below 
the natural degree of strength, if by any means, the influence 
on which it is dependent, be too sparingly furnished. 

In order more perfectly to understand these positions, it is 
necessary to view them in connection with the doctrines per- 
taining to stimuli.f The natural stimuli consist of a variety 
of agents: the different aliments, atmospheric air, caloric^ 
light, sounds, odors, muscular exercise, thought, the various 
passions and emotions of the mind — all these are liable to 

• * This association is based on the fact, that hard thinking exhausts senso- 
sorial power as certainly as hard labor. 

f The word stimuli here, has reference to such agents as setup orinciaese 
the vital motions.. 



46 

modification. To these we add caloric, as it exists in animal 
heat ; the touch and motion of the blood in its circulation 
through the heart, arteries and veins ; as also the touch and 
motion of the lymph and other fluids, secreted and deposited 
in their several receptacles ; and the irritating touch and mo- 
tion accompanying the retirement of the various excrementi- 
tious substances. 

All these stimuli, acting on fibres, vessels and organs, duly 
charged, each with its own inherent vitality, are made tribu- 
tary, as excitants, which invite or provoke the concurrence 
of sensorial influence, for the performance of the functions ; 
and in view of the organization, the whole process may be 
considered as inseparable from the general idea of excitement. 

If the vitality be regularly maintained in every part of the 
system, and the natural and ordinary stimuli be present in 
due order and proportion, the sensorial influence will be«regu* 
larly issued and the excitement will be equable and health- 
ful. Additional stimuli will elicit more than the ordinary 
influences, and be followed by an increase of excitement. 

If such preternatural excitement be long continued, the 
system will be depressed into the condition, which we will 
denominate indirect debility. A state of things, in which it 
may be said, the nervous centres are tired ; and consequent- 
ly, for the time being, furnish a deficient supply of sensorial 
influences. Men staggering in consequence of the use of al- 
coholic drinks, or sleeping profoundly in a state of intoxica- 
tion, exhibit instances of this kind of debility. A similar ef- 
fect may be produced, by inhaling an atmosphere made pre- 
ternaturally stimulant by being loaded with poisqnous efflu- 
via. Persons elaborating a full volume of sensorial influen- 
ces, by exposure to such a state of atmosphere, may be sub- 
jected to the most abrupt occurrence of violent and fatal 
disease. This has been too often verified by imprudent 
strangers, coming from healthful regions, into districts in- 
fected with plague, yellow fever, typhus gravior, &c. 



VITALITY, SENSORIAL INFLUENCE, ETC. 47 

An atmosphere charged with a similar miasm, but of less 
deleterious power, and therefore acting a much longer time 
before its effects are made known, will wear down the ener- 
gies of the nervous centres, and subject those persons who 
may be exposed to its effects, to that state of things, which 
is exhibited in a typhoid condition. 

If any of the stimuli be abruptly abstracted or much di- 
minished, the excitement will be reduced and for a short 
space of time, the sensorial influence will accumulate.* The 
condition of the system immediately after a decisive blood- 
letting or the operation of a very brisk cathartic, corresponds 
to this view of the subject. 

A state of things very nearly analagous to the preceding, 
is produced by certain sedative powers, such as cold and fear. 
The system when shivering in consequence of exposure to 
cold weather, or trembling through fright, is explanatory of 
this view of the subject. In each of these instances, the 
sensorial influence is accumulated for a short space of time, 
during which, there exists that peculiar state of things, 
which we will denominate direct debility; a state in which 
the nervous centres retain the integrity of their organic 
structure and functions, but their influence over the action 
of the superficial capillaries is diminished, because of the 
reduced state of the vitality of those structures. 

These positions, however, though certainly true, admit 
only of a limited and properly qualified application. That 
an increase of stimulus will produce a corresponding exalta- 
tion of excitement, is a truth. But if the stimulus be in- 
creased in a gradual manner, the system will acquire an abil- 



*This accumulation secures reaction after appropriate and well-timed 
blood-letting, or a cold bath, &c. Moreover it will be shown by an experi- 
ment described in the following chapter, that a considerable volume of sen- 
sorial influence is employed, in maintaining the necessary excitement of the 
capillary vessels of the surface. Hence a suspension of the proper and full 
action of the skin, may be productive of alarming consequences. 



VITALITY, SENSORIAL INFLUENCE, ETC. 



ity to elaborate a volume of sensorial influence equivalent to 
the demand of this state of things, and if the exalted condi- 
tion of the excitement be continued, it will become habitual, 
and assume an aspect, analagous to that which is exhibited 
in health. This adjustment is accomplished, under the con- 
trol of the same laws of the organization, by which it adapts 
itself to different climates and in every climate, to its seasons 
and modes of living ; — by which also, it sustains itself, under 
the impositions of tobacco-smoking — chewing and snuffing 
— and dram drinking. If, however, the stimulant agent 
transcend a certain degree of activity, and be continued long 
enough, it may overleap the boundaries of the adapting 
power, iand produce the condition of the system which we 
mean by indirect debility: — and the more deleterious the 
stimulant agent, the shorter the time required for the produc- 
tion of this effect. 

When there is an inconsiderable abstraction of stimulus, or 
when exposure to cold is not long continued, and the sensorial 
influence, therefore, is not much accumulated, the system 
without artificial aid, takes on an increased excitement, and 
readily resumes an equilibrium. An accidental or intentional 
loss of a pound of blood, abstinence from a breakfast or din- 
ner, a shower bath, a casual wetting by a shower of rain : — 
any such occurrence, may be met by persons in ordinary- 
good health, without serious injury; But a sufficiently co- 
pious abstraction of stimulus, or a sufficient degree of cold 
too long continued, will produce a degree of direct debility, 
which will require a judicious interference of art, to secure 
and regulate the reaction, in a manner which shall safely 
bring about a restoration of a healthy excitement. 

This statement perhaps needs qualification. A low tem- 
perature, such as is met in a cold dungeon or other cold and 
damp situation, might reduce the excitement of the capilla- 
ries so gradually, as insidiously to cripple the whole of the 
nervous centres, before the subject of exposure would appre- 



VITALITY, SENSORIAL INFLUENCE, ETC. 49 

hend danger. Jail fever or typhoid fever would be the pro- 
bable consequence.* 

Having thus far considered the four topics, vitality, senso- 
rial influence, excitement, and stimuli, we will direct atten- 
tion to caloric, as it is manifest in animal heat, which al- 
though it be co-ordinate with excitement, requires a distinct 
consideration; because it is subject to such variations, as 
often to require medical interference and skilful management. 
As to the generation of heat in the system, the only cer- 
tainty is, that it is maintained by the functions on which life 
depends. There is no perceptible difference between animal 
heat and that which is produced by ordinary combustion. 

The former as well as the latter, is perpetually and uni- 
formly evanescent, seeking an equilibrium of temperature 
with that of the surrounding atmosphere. Hence it is, that 
the body may be placed in a condition, in which the volume 
of heat generated, elaborated, or liberated, for the time being, 
may be insufficient. Every one knows the need of fire in 
winter and in damp weather; and of putting on clothing 
suitable for preventing the escape of heat, from the surface 
of the body. 

Whether animal heat be sustained by a development of 
caloric in respiration ; or whether it may be more the result 
of an agency, which according to the experiments and opin- 
ions of Leibig, is equivalent to combustion; which he has 
made very probable ; or if it is co-ordinate with excitement, 
&c. ; whether one or all of these considerations are involved 
in the production of animal heat, it must follow with equal 
certainty, that a deficiency of this essential element, will be 
concomitant with a deficient degree of excitement, and that 
whatever may be the relative degree of the importance of 

* The author intends to convey the idea, that the sensorial influence is a 
floating power, which moves at the bidding of stimulation. The practice 
which we denominate counter-irritation, is predicated on this view of the 
subject 

4 



50 VITALITY, SENSORIAL INFLUENCE, ETC. 

maintaining a well-balanced excitement, by the judicious 
application or abstraction of stimuli, no less care is requisite 
for supplying by artificial means, a deficiency of heat, when 
the system is in a state of debility ; — whether it be direct or 
indirect. 

This subject claims the greater attention, because the feel- 
ings of persons in the condition under consideration, are ge- 
nerally fallacious. On a summer's evening, after a very 
sultry day, for some hours the heat is much more oppressively 
felt, after the thermometer is considerably lowered. The 
temperature cannot be higher in fact, when the thermometer 
marks it lower ; yet sensation would make this contradictory 
report. It is not the heat of the surrounding atmosphere 
which causes the inconvenient sensation. It is the tempera- 
ture of the blood, felt disagreeably hot, as it is circulated into 
the bloodvessels of the skin. The capillaries of the skim 
are excited by the heat of the day to an exalted degree, pro- 
ducing indirect debility in those structures, which is followed 
by a profuse and protracted perspiration. On the retirement 
of the sun's rays, these structures fall into a state of feeble 
excitement, which is accompanied by an increased sensibility 
to heat. In consequence of this state of things, the blood 
which carries with it the temperature of the central vessels. 
is unpleasant to the sensation of the skin. The state of the 
thermometer and the condition of the skin as felt by the 
hand of a bystander, concur in supporting this account of 
the matter. If any man doubt the testimony of these two 
witnesses, let him try how exceedingly pleasurable will be 
the relief, which a hot bath never fails to afford, under such 
circumstances. 

By great loss of blood or other considerable and sudden 
evacuation, the system is deprived of its due portion of ex- 
citement, and a similar state of the extreme capillaries occurs. 
The patient complains of insupportable heat : desires to be 
fanned, throws off all covering and calls for cold water and 



VITALITY, SENSORIAL INFLUENCE, ETC. 51 

cold air. His sensation of heat, is in like manner fallacious. 
He is distressed because of a deficiency, not an excess of 
heat. The condition of the fauces, corresponds to that of 
the skin. Hence, the more cold water he drinks, the more 
intense his thirst; like the thirsty sensation which follows 
the excessive eating of ice or snow in winter. In such in- 
stances, the intensity of the cold applied to the fauces dimin- 
ishes the excitement and increases the sensibility of the 
blood-vessels of the throat ; — this done, they feel the heat of 
the circulating blood. 

Whilst thus in view of the skin, we can only express our 
regret, that anatomists nor physiologists, have as yet enabled 
us to determine, what proportion the skin and so much of 
the cellular structure as lies immediately subjacent to it, bear 
to the remaining soft solids. 

As this inquiry has escaped the attention of writers on 
those important branches, a very great degree of certainty 
must not be expected ; and in fact is not requisite for carry- 
ing out our intended explanations. 

We will assume the hypothesis, that the skin and cellular 
structure, as they are spread out and exposed to the vicissi- 
tudes of temperature, constitute one fourth part of the soft 
solids. And when it is considered, that the bronchi and air 
cells of the lungs, and in fact, the whole cellular structure 
by the laws of association, may properly, in some degree, be 
taken into the account ; it would seem, that our computation 
cannot be extravagant. Besides, the great vascularity of the 
skin cannot be doubted : although the most remote from the 
heart, whilst in a living state, no part of it can be divided 
without an effusion of blood. According to this estimate, 
external temperature may seriously affect " the strand upon 
which terminates one fourth part of the arterial blood, and 
upon which one-fourth of the venous ebb commences ; — and 
upon which "repose the external sentient extremities, of 
the whole nervous system." 



52 AX EXPERIMENT. ETC. 



CHAPTER IL 

AN EXPERIMENT CONFIRMATORY OF THE PRINCIPLES LAID 
DOWN IN THE FOREGOING CHAPTER. 

When we rise out of bed on a winter's morning, after an 
agreeable night's rest, having slept in a room without fire ; 
by a careful inspection of the skin, it will be found to be 
somewhat pallid, with the appearance which is called cutis 
anserina.* In this condition, if we approach near to a brisk 
fire, with the skin uncovered, the sense of heat will be very 
acute. Having taken a position at which the heat can be 
endured, but hot enough to exercise some degree of forti- 
tude : m a few minutes the severity of the sensation will 
abate — the excitement of the skin will be increased, the ca- 
pillaries will be filled, and the fulness of the veins will evince 
a sreat freedom of the circulation- Either the extinction of 
the sensibility, or an improvement in the radiating power of 
the skin, or these two circumstances co-operating, will make 
it practicable to retain the position much longer than the ex- 
perimenter would at first suppose it could be done. Let the 
same distance be firmly maintained, turning from side to side 
for relief, as the heat shall seem to increase, and presently 
the skm will be reddened, and a removal to a greater dis- 
tance, will become unavoidable^— and if favorable arrange- 

^Goose's skin. This appearance is consequent on the contraction of the 
capillar}' vessels, which in this condition are very empty of the circulating 
fluids. There is also some degree of spasm, partly from the same cause, but 
chiefly because of the increased vitality produced by sleep. Similar appear- 
ances may be observed, if in health, on any morning- cold enough to produce 
a similar contraction of the capillary vessels. Cullen's spasm, so conspicu- 
ous in his theory of fever, is the same thing, as it respects the contraction of 
the capillarv vessels of the skin. 



AN EXPERIMENT, ETC. 53 



merits be made for the purpose, the experiment will be fol- 
lowed by a free and agreeable perspiration. 

About the time when the heat becomes insupportable, in 
addition to the redness of the skin, the pulse will become 
frequent, accompanied by a throbbing of the arteries of the 
face, the temples, and the hinder part of the head ; making 
it manifest, that the excitement of the surface is exalted much 
above its ordinary state. The increased frequency of the 
pulse, shows, that while the superficial capillaries are excited 
by the agency of heat, the power of the heart and central 
vessels is proportionally diminished.* So effectual is the 
above experiment, that, whosoever shall have tried it pro- 
perly, will admit, that an excitement of the capillaries thus 
suddenly produced by the agency of heat, must check upon, 
the stock of sensorial influence, in a proportion, correspond- 
ing to the computation which we have made in regard of 
the skin ; and if so it is a vastly important fact, that the 
physician can imperiously and safely coerce, one fourth 
part of the power which may be expending itself in morbid 
action upon the central vessels, and direct it upon the sur- 
face ; and can maintain this superficial action long enough, 
to subdue the general tendencies to irritation, or lesion. 

But to return to the experiment. The sensibility to heat, 
which is felt so acutely upon the first approach to the fire in 
the morning, is consequent upon an exalted condition of the 
vitality of the skin through the instrumentality of sleep. 

The agency of the heat in the course of a few minutes, 
diminishes the sensibility but increases the excitement of 
capillaries. By this fact it appears, that the exalted sensi- 

* The frequency of the pulse denotes a corresponding degree of debility 
in the heart and arteries. By the agency of heat, the capillaries are ex- 
panded, giving admission to an increased quantity of blood. The increased 
excitement of the surface calls off much of the sensorial influence, which oth- 
erwise would exert itself upon the heart and arteries. Hence the heart's 
power is diminished, as the action of the superficial capillaries is increased. 



54 AN EXPERIMENT, ETC. 



bility, tending to a condition of irritability, is corrected by 
timely excitement. 

By continuing at such a distance from the fire, as at the 
first is but little uncomfortable, an insupportable sense of 
of heat will presently be produced. The sense of heat 
which recurs when the skin is reddened, proves that the pre- 
sence of the blood accompanying the increased excitement 
of the capillaries, increases the vitality of the structures. 
This subsequent occurrence of the sense of heat, differs very 
materially from that felt in the first instance, and is the result 
of the increased action and consequent accumulation of blood 
in the capillaries ; and with the exception, that the arterial 
and venous portions of the structures, are so equally affected 
that upon the retirement of the external heat, which is the 
exciting cause, there is an immediate return to a healthful 
condition, the unpleasant sense of heat felt in the skin, is 
similar to that felt in inflammation. 



55 



CHAPTER III. 

DESCRIPTION AND EXPLANATION OF DISEASE, WHEN 

CONSEQUENT ON EXPOSURE TO COLD OR 

INCLEMENT WEATHER. 

With the intention to show the practical utility of the fore- 
going elementary principles, we will turn attention to some 
of the leading phenomena, which are present in the forming 
state of disease, when consequent on atmospheric influence. 

An imprudent exposure to cold and damp weather, di- 
minishes the excitement of the capillary vessels of the sur- 
face, and consequently accumulates the sensorial power more 
or less, according to the vigor of the patient, and the time 
and other circumstances attending the exposure. Hence it 
is, that disease, when the consequence of such exposure, as- 
sumes the most violent forms of simple inflammatory action. 
In many instances, if the subject of exposure be robust and 
in full health, the ultimate effect will be, a pleurisy or pul- 
monics.* 

If corpulent, or one in the habitual use of ardent spirits, 
the effect will wear a similar aspect, but will be modified by 
the temperament or habits of the patient. In an instance 
of corpulency, the energies of the system are ever on , the 
stretch, for the support of so large a bulk of flesh. And the 
sensorial centres of the drunkard, are constantly oppressed 

* It will be perceived by the reader, that this last position is predicated 
on the belief, that the sensorial influence which governs the action of the 
vascular system, if not expended by an equable circulation, and especially 
if the temperature of the skin be a long time so low as to prevent its expen- 
diture in maintaining a full excitement of the external capillaries, it is con- 
centrated, in accumulating volume and power, upon the heart, arteries, lungs 
and other important viscera. 



56 DESCRIPTION AND EXPLANATION OF DISEASE. ETC. 

by the stimulant power of his poisonous beverage. In these 
and particularly the latter, we do not expect the same bold 
arterial action, which is displayed in cases of pleurisy or pul- 
monics in persons of common stature and temperate habits. 
They more frequently become the subjects of typhoid action. 

Exposure, accompanied with protracted exertion, such as 
walking, riding on horseback, or laboring so as to induce ex- 
cessive weariness, because of the exhaustion of the sensorial 
influence, is often productive of disease of inflammatory ten- 
dency, though not determining upon the vital organs : such as 
rheumatism, catarrh, &c. in winter and spring : and dysen- 
tery and other enteritic affections, in summer and autumn. 
In such instances, fatigue induces general debility, which 
continues till gradually corrected by rest. Whilst debility 
continues, in some subjects, the action of the extreme capil- 
laries continues to be deficient, and the vitality of the fascise 
and cellular structure of the extremities becomes exalted to 
the condition of irritability. As the sensorial power is re- 
generated, irritable surfaces take on excessive, that is morbid 
action, which continues until the peculiar kind of irritated 
condition, which is rheumatism, is established. In others, 
the mucous surfaces are involved : as in cases of catarrh, and 
take on irritated action. And again, in others, similar cir- 
cumstances tend to the establishment of irritated action on 
the mucus surfaces of the intestines. So also, old persons 
whose mucous surfaces are enfeebled through age, and infant 
children of very delicate and phlegmatic temperaments, and 
especially if fat, by exposure, without fatigue, are readily 
subjected to bronchitis. 

In all these instances of disease, although they obviously 
differ in respect to the various structures upon which they 
commit their ravages, still in their general characteristics, 
they are similar. The only real difference, is, the result of 
the different condition of the surfaces, which become the 
seats of morbid action, and that of the sensorial influence, by 



DESCRIPTION AND EXPLANATION OF DISEASE, ETC. 57 

which the morbid action is sustained. Catarrh, cynanche 
tonsillaris, croup and affections of minor importance ; as, 
head-ache, tooth-ache, &c. are all consequent on accumulat- 
ed vitality, that is, irritability of the respective structures, or 
surfaces, which become the seat of diseased action, and are 
continued by the uniform tendency of the sensorial influence 
to obey the call of irritation. In all these instances, the com- 
mon notion is, that the subjects of them have taken cold, and 
common sense, in this, as in most other things, is according 
to truth. Cold alone, by its sedative influence, acting on 
the system in other respects in good health, is the only agent 
concerned in effecting the predisposition, and the disease is 
violent reaction, the natural result of a morbid accumulation 
of vitality, which invites and provokes a determination of 
sensorial influence to the irritated surfaces, which are the 
seats of these diseases. 



5$ EXPLANATORY OF IDIOPATHIC FEVER. ETC. 



CHAPTER IT. 

EXPLANATORY OF IDIOPATHIC FEVER. OR FEVER. PRO- 
PERLY SO CALLED. 

The preceding chapter is an attempt to explain disease, as 
it is suddenly induced by change of temperature, in persons 
previously in good health, in healthful seasons and*climates. 
In respect of the local affections,, croups, catarrhs, rheuma- 
tisms, tooth-ache. cVc. although the particular surfaces and 
structures which are affected in these instances; by the agency 
of cold, have their vitality increased so as to produce alarm- 
ing local irritation, yet the sensorial influence in the aggre- 
gate, is not sufficiently accumulated, to produce great excite- 
ment throughout the whole svstem. 

In sickly places and seasons, the atmosphere is charged 
with poisonous effluvia, malaria, which, in co-operation with 
the heat of summer, stimulates the system into a state of in- 
direct debility: consequently, the functions are imperfectly 
performed : the skin falters in common with the other organs 
and structures : the blood is imperfectly elaborated : the ner- 
vous centres are not fully sustained, and the censorial influ- 
ence is generated too sparingly for the demands of the sys- 
tem. Hence the vitality of the capillaries, is reduced below 
the grade of health. It follows, that the natural stimuli are 
not felt in their ordinary degree, the excitement languishes : 
animal heat, which is dependent on excitement for its due 
degree of temperature, is diminished : and the whole current 
of the circulating fluids, moves slowly. Those branches of 
the sanguiferous system, the farthest removed from the heart, 
must necessarily languish most. The capillaries oi the skin, 
therefore, must not only receive a deficient supply of blood. 



59 

but the functions of that structure must be imperfectly per- 
formed. The sustaining power of the system, by which it 
defends itself against the hurtful influence of reduced tem- 
perature, during cold nights and wet weather, is the excite- 
ment of the skin ; which, in these instances, is much below 
the grade of health. If there should occur any occasion for 
a person in such a condition, to make a little more than or- 
dinary exertion for the space of a single day, or even for a 
shorter period, it may so far check on the sensorial sources, 
and so reduce the force of excitement, that the cold of one 
succeeding night, or of one rainy day, may subject the sys- 
tem to an attack of fever. The greater the debility under 
such circumstances, the more morbid will be the effect of 
exposure to cold ; and vice versa. The first grade of fever 
the result of this state of things, is intermittent, the second 
is remittent, the third continued, synochoid or typhoid. 

We learn from anatomy, that the ramifications of the 
nerves correspond to the branches of the arterial system. 
Perhaps it is sufficiently evident, that every artery, extending 
to the most minute capillary structures, has its accompanying 
nerve. We may then infer, that the arterial action is affected 
by the influence of the nerves, and in turn, the power of the 
nerves to maintain their influence over the arterial action, is 
materially sustained by the presence and healthful condition 
of the blood. Every branch of the nerves has connection 
with its respective sensorial root ; — the cerebrum, the cere- 
bellum, the spinal chord, or the ganglia with their sympa- 
thetic apparatus. As vegetation is sustained, partly by the 
elementary principles taken up by the roots of the trees, 
shrubs and plants, but more by those inhaled from the atmo- 
sphere, through the functions of the foliage ; — so the nerves 
are supported, partly by influences derived from their respec- 
tive sensorial roots, but more by the etherial principles and 
genial warmth, continually conveyed to them by the circu- 
lating blood. 



60 EXPLANATORY OF IDIOPATHIC FEVER, ETC. 

The blood is perpetually generated and kept in healthful 
condition by the agency of organs and functions ; is elabo- 
rated out of the materials which constitute the aliments, 
simultaneously receiving such other etherial influences from 
the atmosphere, as are necessary for its perfection, by the 
instrumentality of the liver, lungs and skin, being relieved of 
its carbon, by Liebig's combustion. Hence it is, if the blood 
be too highly charged, with the elements which afford nutri- 
ment and comfort to the sensorial sources and the nerves, the 
sensorial influence is speedily elevated. So also, a mere ex- 
citant, by producing a more than ordinary celerity in the cir- 
culation, for a certain length of time, will induce a similar 
elevation. A glass of good old wine in aid of an agreeable 
dinner, will furnish an example explanatory, of the first posi- 
tion. An inhalation of nitrous oxyd gas, a moderate portion 
of dilute alcohol, smoking a cigar, an appropriate dose of 
opium, or the respiration of an atmosphere impregnated with 
certain gases, furnish occasions explanatory of the second. 

In conformity to the principles already submitted, the ner- 
vous influence may be elevated in either of these ways, 
without immediate injury; and perhaps so as to be perfectly 
innoxious ; if it be not too much elevated, nor be too long 
continued ; and an habitual exaltation may be wonderfully 
repeated, if its effect be directed into the channel of the vo^ 
luntary motions. A hammerman, in one of the forges of 
North Carolina, was accustomed to drink two quarts of com^ 
mon rum or whisky, and prepare his ton of bar-iron, per day. 
And a system trained by habit, may for a long time resist the 
destructive agent, alcohol, even if permitted to wear down 
the effect of the stimulation, through the channel of vascular 
action. This is done every day by the sleeping drunkard. 
But any such instance of the exaltation of the sensorial in- 
fluence, not being habitual, is followed by an irritable condi- 
tion of the sanguiferous system, This state of things befalls 



EXPLANATOKY OP IDIOPATHIC FEVER, ETC. 61 

those who are incidentally drawn into a debauch, or are by 
any means considerably excited. 

If an excess of food be repeatedly taken into the stomach, 
of course furnishing an excessive supply of nutriment, the 
blood-making organs and functions will become embarrassed, 
and the blood will be imperfectly elaborated. The circula- 
tion will then become languid, because of its too great vo- 
lume, and not being kept in a state of perfect assimilation, it 
will not furnish the sensorial sources, with the necessary sup- 
ply of the elements, in the condition required for the elabora- 
tion of the sensorial influence. Hence the heaviness and 
dullness, consequent on repeated gluttony; presenting the 
condition of the system, which is denominated plethora j 
and when in this state, any exertion by which considerable 
fatigue is superinduced, any protracted exposure to cold or 
wet weather, or sleeping in a cold apartment, without the 
necessary bed-clothes, will in most instances, produce a dan- 
gerous concentration or introversion of the blood, upon the 
blood-vessels of the abdominal viscera ; and unless the error 
be speedily corrected, it will be followed by fever with irri- 
tation of some one or more of those organs ; and this state 
of the abdominal viscera is the most conspicuous character- 
istic of bilious fever. This morbid state of things, when 
•consummated, is followed by that form of fever that is now 
•called congestive. In this fever the circulation is so languid 
and the blood so deteriorated, that in many instances, it is 
irretrievably fatal. 

The importance of this view will be the more obvious, 
when it is considered, that the condition of the blood is ma- 
terially affected by the state of the skin ; which at the same 
time that it constitutes a covering for the whole body, per- 
forms many functions, one of which is analogous to that of 
respiration. Presenting the blood in a condition of corres- 
pondence with the atmosphere, through its instrumentality, a 
supply of the necessary etherial influence is furnished, for the 



t52 EXPLANATORY OF IDIOPATHIC FEVER. ETC. 

support of the capillaries which give origin to the veins. As 
the etherial influences which unite with the blood, in its cir- 
culation through the lungs, supply the pabulum of vitality 
and sensorial power to the arterial system, so corresponding 
influences, received through this function of the skin, is ne- 
cessary in aid of the more copious provision made by the 
instrumentality of the lungs,, to maintain a healthful condi- 
tion of the returning circulation. A state of plethora is the 
more injurious, therefore, since, at the same time that the 
blood-making organs are inadequate to the task imposed on 
them by the increased volume of the blood, the introversion 
which accompanies it, greatly increases the thraldom of the 
functions of the viscera, by preventing the auxiliary opera- 
tions of the skin. 

Intense cold acting for a short time, on a system well sus- 
tained by sufficient vitality, does no injury. Its effects are 
salutary, being speedily corrected by a perfect reaction. But 
a protracted exposure to a moderate degree of cold, insidi- 
ously brings about a torpid condition of the capillary struc- 
tures of the surface, with a simultaneous diminution of ex- 
citement. A corresponding volume of the sensorial influ- 
ence is detained and accumulated in the system, and if it be 
continued, will subject it to a violent attack of disease. This 
is the state of things in almost every case of inflammatory 
fever, as it occurs in the winter and spring seasons of the 
year. The sensorial influence is so amply furnished, that 
exposure to the weather for one day, is sufficient to produce 
an attack of pulmonitis : especially if the exposure be accom- 
panied by exercise of a kind to induce fatigue, and the pa- 
tient inconsiderately retire to bed without having established 
the necessary reaction. The excitement of the cuticular 
surface, is so much diminished by the fatigue, that the capil- 
lary structures become constricted. "When the system shall 
have rested, the sensorial influence will be accumulated and 
the nervous centres will be in condition to maintain it, at the 



EXPLANATORY OF IDIOPATHIC FEVER, ETC. 63 

grade of full health : The constriction of the surface, 
places, perhaps, one-fourth part of the soft solids, in a state 
of preparation to resist a return of the blood, the absence of 
which is the cause of the stricture, and by the laws of asso- 
ciation, the capillary structures giving origin to the pulmo- 
nary veins, will assimilate to that of the external surface. In 
this state of things, we have the extremities of the arteries, 
partially locked up by the stricture, and the skin contracted, 
constituting a perfectly fitting bandage, making universal re- 
sistance to the arterial circulation, whilst it- simultaneously 
affords a corresponding assistance to that of the veins ; and 
the necessary result is, an injected condition of the arterial 
system. 

The aorta extends its branches throughout the whole body, 
spreading its ramifications over the entire surface, internal as 
well as external. The pulmonary artery, with an equal 
calibre, has all its branches confined within the limits of the 
lungs. The aorta receives the blood from the pulmonary 
veins, whilst the pulmonary artery is compelled to receive 
the larger volume sent up by the vena cava, from the entire 
mass of the body. It follows, therefore, with as great cer- 
tainty as physiology can furnish, that the pulmonary vessels 
are particularly liable to painful injection by the stress im- 
posed on the arterial system. The circumstances which at- 
tend on a case of pulmonitis, are in accordance with this 
statement. , 

It has been shown, that whenever there is a diminution of 
excitement, there will be an accompanying deficiency of ani- 
mal, or vital heat. In the commencement of the attack, the 
skin is pale, constricted and cold ; the lips and the skin sur- 
rounding the mouth and eyes, are livid • and the pulse is 
tense, contracted and frequent. In confirmation of the fact, 
that the pulmonary vessels are morbidly injected, the patient 
complains of a distressing sense of tightness and fullness of 
the chest j his respiration is hurried and oppressive ; and in 



64 EXPLANATORY OF IDIOPATHIC FEVER, ETC. 

the midst of these appearances, a lancinating pain is felt in 
the lung : which is followed by a cough and an expectora- 
tion, commonly more or less tinged with blood. 

With these facts in view, we cannot doubt the truth of 
the position, that the pulmonary Vessels are painfully inject- 
ed, even to a degree of lesion sufficient to produce extravas- 
tation of blood ; which is thrown off by expectoration. "We 
then safely infer, that the lesion produced by the injection, 
constitutes the inflammatory point of this disease, and is the 
sole cause of its protraction. It is a well known fact, that 
all the other phenomena which mark an attack of pulmonitis. 
may occur, if the pain be absent, and all pass away with- 
out any considerable subsequent inconvenience to the pa- 
tient. 

The chill and shiverings, are necessarily attendant upon 
the arrest of the circulation, produced by the injection. The 
accumulated sensorial influence, having at the first determin- 
ed its course of expenditure through the most direct and nat- 
ural channel, the heart and arteries, being arrested in that 
course by the injection of the pulmonary branches, is ab- 
ruptly transferred to the muscular structures. And this sud- 
den transition, probably saves the system from the mischiefs, 
which might otherwise be the effect of an overwhelming re- 
vulsion of that influence. 

Hence the shivering, so far from being an alarming symp- 
tom, affords proof, that the system is prepared to avail itself 
of this alternative for safety. By the convulsive effort set 
up in the muscular structures, a very rapid expenditure of 
sensorial influence is effected. Any violent muscular exer- 
tion, continued for a few minutes only, so exhausts the senso- 
rial influence, as to make it difficult for the system to main- 
tain the necessary motion of the heart and lungs ; and if con- 
tinued too far, the heart and blood vessels may fail to circu- 
late the blood. This occurrence takes place, when a man, 
or any other animal, through fright, is run to death. 



65 

Pain, alsOj in a degree proportionate to its severity, effects 
an expenditure of sensorial power. So soon therefore, as the 
existing excitement, together with the muscular shivering, 
and pain, when present, have by their co-operation, sufficient- 
ly expended the sensorial influence, which is maintaining 
the injected state of the arterial system, the struggle subsides ; 
the pulmonary veins give a free passage to the whole current 
of circulating blood j the chilly sensation retires, and the hot 
stage of the fever commences. The system, however, being 
highly charged with sensorial influence, the arterial action is 
still kept up with excessive force. The skin too, in its turn, 
from the same cause, becomes considerably excited. 

According to this view of the events which occur in a case 
of pulmonitis, it would appear, that the blood vessels are lia- 
ble to lesion, during the continuance of the chilly state of fe- 
ver only ; that the more highly the system is charged with 
sensorial influence in any given case, the more certainly a 
fever in such a case, will be ushered in with a violent chill 
and shivering ; and that the greater the degree of exhaustion 
of sensorial influence in any given case, the more certainly it 
will commence without a chill or shivering. And finally, we 
may also infer, that pulmonitis, or any other similar affec- 
tion, is the result of a mere reaction of the system, which, in 
consequence of the previous suspension of it natural motions, 
exerts itself with a violence too great for its own safety; a 
state of things in which, exalted excitement begins to play 
at the centre, while yet the capillary structures are in a state 
of torpor ; and before they can be adjusted, so as to take on 
a corresponding increase of their functional action, and se- 
cure a free and equable circulation, the arterial system be- 
comes injected to a decree of tension, which produces lesion. 

Considering the violence of excitement exhibited in a case 
of pulmonities, which is a mere reaction of the system, with- 
out the concurrence of any preternatural stimulant power to 
excite or maintain it, what havoc might we not expect, should 
5 



66 EXPLANATORY OF IDIOPATHIC FEVER, ETC. 

a person predisposed to such an attack, quaff down a strong 
charge of ardent spirit ? How imminent the danger, that the 
r lungs would be engorged to an apoplectic state, producing a 
very sudden death. 

In a similar way, a person fully predisposed to disease with 
accumulated sensorial influence, by coming into a city or dis- 
trict, where the atmosphere is highly charged with malaria, 
is liable to be seized at once, by the prevailing endemic, and 
in one of its most alarming forms. Such an individual, pro- 
bably, at first would feel a degree of hilarity, as if he were 
under the influence of a glass of wine ; but within a short 
time, he would experience lassitude, pains, rigors, chills, &c. 
all the symptoms which usher in an alarming disease. And 
if he should remain within the limits of the poisonous atmos- 
phere, which shall have proved so dangerous a stimulant, it 
is not difficult to perceive, what must await him in the issue 
of the case. 

The difference which is more particularly worthy of no- 
tice, between an ordinary case of pulmonitis, or other form 
of simple inflammatory disease, and one of a malignant fever, 
is, that in the former, an accumulation of sensorial influence 
prepares the system to assume an exalted state of excitement, 
and in course, when the accumulated power shall have been , 
expended, it will be well disposed to resume its ordinary 
grade of action. In the latter, a deleterious stimulant coer- 
ces it, maintaining the elevation, till it produces a pernicious 
state of indirect debility. In the former, the degree of dan- 
ger which accompanies it, will be measured by the degree of 
lesion which may be produced by the first exacerbation ; 
which lesion constitutes its inflammatory point. In the lat- 
ter, not only a similar degree of lesion may occur, but often, 
the' most fatal congestions are established by the inevitable 
protraction of the paroxysm. 

In considering a constricted state of the surface, as an in- 
separable incident in the commencement of fever, we are not 
alone. Dr. Cullen predicated his whole svstem. of the theo- 



EXPLANATORY OF IDIOPATHIC FEVER, f ETC. 67 

ry and practice, upon this fact. His theories upon the sub- 
ject of spasm are justly exceptionable. His attention to this 
fact, however, furnishes a strong evidence in our favor. And 
the detail of facts which distinguish his work, will continue 
to do him honor as an accurate observer of nature, till disease 
shall cease to commit its ravages upon the human body. 

A constriction of the capillary structures, we have present- 
ed, as holding a conspicuous place, in producing that inject- 
ed condition of the arterial system, which is the cause of 
pulmonitis, and of the chilling sensation and shivering, with 
which that disease commences. We now proceed to show 
the undoubted affiliation, which obtains, between this affec- 
tion and an ordinary intermittent fever. 

The primary, remote cause of an intermittent, probably is, 
that indescribable something, denominated marsh miasm. 
There may be a poisonous gas, which, combining with the 
atmosphere, so stimulates the system, as to induce a degree 
of indirect debility ; but the amount of its agency has not 
been computed, nor the manner of its action denned. In re- 
gard of miasmatic regions, there is an obvious fact which 
particularly claims attention. In those districts of country 
where intermittents generally prevail, at the same time that 
the days are very warm, the nights are exceedingly cool, for 
the season of the year. The atmosphere is daily heated by 
the sun's rays, but the chilliness of the wet earth, together 
with the incessant exhalations arising out of it, afford such 
ready and perfect conductors for the escape of heat, that the 
sun is scarcely below the horizen, before the w T hole region is 
cooled. If then the marsh miasm as a stimulant, in conjunc- 
tion with the heat of the weather, co-operate with fatigue, 
&c. to place the system in a condition of indirect debility, 
according to the degree of that debility, the capillary struc- 
tures will be disabled, and the skin made more subject to 
the sedative effe'ct of cold. The continued agency of the 
miasm, and the reiterated application of the sedative power 
of the cool night air upon the surface, will at length bring 



68 EXPLANATORY OF IDIOPATHIC FEVER, ETC. 

about such a constricted state of the capillary structures, as 
shall be sufficient to subject the arterial system to a state of 
injection. We are not at liberty to consider the volume of 
sensorial influence in such a case, potent enough to exalt the 
excitement sufficiently to. produce lesion. In that event, 
the result would be pulmonitis. It is rather probable, that it 
is less than is usual at the same season of the year, and in 
more healthful places. But the indirect debility, and con- 
sequent constriction of the capillaries, sooner or later bring 
about an injected state of the arterial system ; and although 
the volume of sensorial influence, j may be insufficient to 
to institute or maintain a reaction powerful enough to 
effect lesion, yet in consequence of the cold nights, the 
capillaries of the surface will become so liable to a state of 
atony and the excitement be confined within limits so nar- 
row, through the compression made by the stricture of the 
skin, that an amount of reaction will be produced, sufficient 
for a temporary injection of the arterial system ; and of course 
the appearances of the chilly state of fever j except only that 
no inflammatory lesion is produced. In consequence of the 
previous debility, the volume of sensorial influence is so 
much below the standard of perfect health, that the utmost 
exertion of the heart and arteries, fails to produce any lesion 
of the pulmonary vessels ; and this Jast particular consti- 
tutes the only important difference, between a paroxysm of 
an intermittent, and the first exacerbation of a pulmonitis. 
This will be made completely obvious, if we present a sim- 
ple statement of the events as they occur in each. 

A paroxysm of an intermittent fever is ushered in by the 
following appearances: langour, or sense of debility : a slug- 
gishness : yawning or stretching : face and extremities pale ; 
features shrunk ; the bulk of the whole system seems di- 
minished ; and the skin of the whole body appears constrict- 
ed, as if cold had been applied. The patient feels a sense of 
coldness, first in his back, and presently passing over his 



ETC. 69 

whole body ; till a general tremor of the limbs and rigor of 
the trunk are produced. As the sense of coldness commen- 
ces, the pulse becomes small, frequent and irregular ; the res- 
piration contracted, frequent and anxious ; and sometimes at- 
tended with cough, &c. These are the most conspicuous 
features which characterize intermittent fever, according to 
Dr. Cullen, the accuracy of whose description has been uni- 
versally approved. Let us now attend to his description of a 
pulmonitis, (pleurisy.) " The disease," says he, " almost al- 
ways comes on with a cold stage," and by a cold stage he 
means the entire description as given above. He proceeds, 
"and is accompanied with the symptoms of pyrexia." Let 
it be remembered, that Dr. Cullen avails himself of the cir- 
cumstances and appearances, as they occur in an intermittent 
fever, as being explanatory of fever in general. Therefore, 
when he says "the disease almost always commences with 
a cold stage, and is accompanied with the other symtoms of 
pyrexia," it is his indisputable meaning, that a pulmonitis 
(pleurisy) comes on like a paroxysm of an intermittent. In 
what then do they differ ? In nothing but the degree of 
force, which being greater in the one, produces lesion ; 
which done, the case becomes a disease of the lungs, and is 
inflammatory, because of the lesion. Hence any explana- 
tion which can be satisfactory, as to the appearances of the 
chilly state of the fever, in the one, must be equally so in 
the other. A difference may be regarded with a reference to 
the remote cause in each. Cold alone produces the predis- 
position in the one case, accumulating the sensorial influence 
in a system armed with the whole stock of sensorial power. 
In the other, miasm induces debility, subjecting the system 
to a constricted state of the capillaries, by a degree and con- 
tinuance of cold, which in more perfect health might be al- 
together innoxious. Cases explanatory of this affinity be- 
tween a pulmonitis and an intermittent fever, are continual- 
ly occurring in the marshy country near the sea coast ; one 



70 EXPLANATORY OF IDIOPATHIC FEVER, ETC. 



or the other of these two forms, is- generally prevalent, fol- 
lowing the seasons, in an order corresponding to the princi- 
ples which have been submitted. The periodicity of inter- 
mittent^ presents no serious difficulty in respect of these ex- 
planatory views. 

If there exist in the case, sufficient energy for effecting an 
adequate accumulation of sensorial influence, every night to 
ensure a daily reaction, after the cold night air shall have ex- 
erted its sedative influence on the state of excitement, it 
will be an instance of the quotidian form. If it require two 
nights to charge the system sufficiently to bring on a reac- 
tion it will be" an instance of a tertian form. And if three 
nights be necessary to place the system in a similar condi- 
tion, the case will assume the form of a quartan. 

But we have respectable authority in support of the doc- 
trine of lunar influence m the production of an intermittent. 
Doctor Jackson, by a record kept on his almanac, satisfied 
himself, that a considerable proportion of the cases which 
occurred through a season, commenced within seven or eight 
days of the foil or change of the moon. Be it so, and in fact, 
it could not be otherwise, since there is no day, which is not 
within seven or eight days of the full or change of that sa- 
tellite. It is a fact of common notoriety, that in as great a 
proportion of instances, as are equal to Doctor Jackson's ca- 
ses, the weather is colder, and not unfrequently wet, within 
seven or eight days of the full or change of the moon. To the 
vicissitudes of temperature which attend on the phases of the 
moon, and to no other influences, are to be referred all the 
imaginary lunar agencies concerned in the production of fe- 
ver. The numberless variations and modifications of inter- 
mittents, so far as they actually exist, are the result of various 
temperaments and their accompanying liabilities to such spe- 
cial irritations, as may be present at the commencement of 
the attack, or as may be superinduced by subsequent occur- 
rences, mal-practice, &c. &c. 



THEORIES OF FEVER, ETC. 71 



CHAPTER V. 

CONCLUDING WITH WHAT THE 
AUTHOR THINKS APPROXIMATES TO THE TRUE ONE. 

Dr. Cullen taught, that the first change induced in the 
animal system by the operation of the exciting cause of 
fever, is a diminution of the energies of the brain ; that all 
the powers of the body and all the faculties of the mind ; — 
that the functions of sensation and motion ; — the processes 
of respiration, circulation and secretion, all fail or are dimin- 
ished in the general debility ; — that after a certain time, a 
morbid increase of some of the functions, especially of the 
circulation, takes place, with an augmentation of heat ; — that 
these three states , — of debility, — of cold, — and of heat, bear 
to each other, the relation of cause and effect ; — that the first 
state is the result of the sedative or debilitating influence of 
contagion, marsh miasmata, cold or any other exciting cause ; 
and the subsequent states, the result of the first ; — that the 
debility produces all the phenomena of the cold stage, and 
especially a spasmodic constriction of the extreme arterial 
vessels. " Upon the whole," says Dr. Cullen, " our doctrine 
of fever, is explicitly this ; — the remote causes are certain 
sedative powers applied to the nervous system, which dimin- 
ishing the energy of the brain, and thereby produce a debility 
in the whole of the functions, and particularly in the action of 
the extreme vessels." Here is a description of the events 
which occur in fever ; but the attempt to account for and 
explain them, is altogether a work of imagination. 

Dr. Brown, like his predecessor and preceptor, attributes 
all fevers to debility, and affirms, "that the distinctions 
which physicians have made about the difference of fevers. 



72 THEORIES OF FEVER, ETC. 

are without foundation ; that they are all the same : differ- 
ing only in degree, &c; the cause of all these diseases from 
the simplest and mildest intermittent, to the jail fever and 
plague, is the same with that of diseases not febrile ; to wit, 
debility; differing only in this, that it is the greatest debility 
compatible with life, and not long compatible with it." This 
theory is very brief and apparently simple. It is, however, 
equally fanciful and unsatisfactory, as that of Dr. Cullen. 

So late as the year 1829, from Dublin, from the largest 
hospital for the reception of fever cases in the British empire, 
a different doctrine was put forth by Dr. Stokes. " Common 
epidemic fever,'" says he, " especially when contagious, has 
not appeared to me, at any time, to be essentially inflamma- 
tory; — adynamic fever, a denomination of typhus fever, 
which I shall employ, as I have hitherto done, to express — 
the putrid or malignant fever of Sydenham : — the slow ner- 
vous fever of Huxham ; — the nervous fever of common lan- 
guage ; — the synochus. typhus mitior and gravior, of Cul- 
len ; — the jail and hospital fever : — the essential fever of the 
French ; — the epidemic of the Irish writers ; — the contagious 
of Bateman ; — the typhus of Dr. Armstrong : — and the pro- 
per idiopathic of Dr. Clutterbuck : whether it exists sepa- 
rately or independently, or is combined with any other forms 
of febrile disease, sporadic or symptomatic, typhoid or ady- 
namic fever, I consider to be generally symptomatic of mor- 
bid changes in the physical character of the blood." In in- 
flammatory fever on the one hand there is increased action : 
on the other, debility is almost the immediate consequence. 
On account of this debility being an essential characteristic 
of typhoid fevers, I denominate them adynamic." 

By this extract it appears, that morbid changes in the physi- 
cal condition of the blood, in the opinion of Dr. Stokes, are 
produced by the causes which induce fever : in course, the 
morbid condition of the blood, in his opinion, must act as a 
secondary cause in maintaining the disease. This fault in the 



THEORIES OF FEVER, ETC. 73 

state of the blood, is one of the morbid circumstances, which 
occur in the course of the formation and establishment of 
fever. The cause of it is specified, and its proper place in 
the train of events as they occur in fever, is assigned to it, in 
chapter IV. 

The same doctrine was published by Dr. Baine of London. 
Dr. Clanny, however, taught somewhat differently. Instead 
of regarding a vitiated state of the blood as the essence of 
fever, he believes the proximate cause of it, to be a want of 
power m the system to form blood — "a cessation of chylifi- 
cation and consequently of sanguification. Chylification like 
secretion, is a function of the brain, which under peculiar 
states of the atmosphere is impaired, and in severe cases is 
suspended altogether. Hence, typhus fever." 

But in opposition to all such views of fever, it is zealously 
and ably maintained, that fever is strictly a local disease, that 
it has its primary and essential seat in one organ, and that it 
consists of inflammation of that organ. 

Dr. Clutterbuck, who may be regarded as one of the most 
distinguished advocates of this opinion, in one of the best 
works on the subject, contends that fever of every denomi- 
nation and of every degree, is the result of inflammation ; — 
that the appearances which have led to the conclusion that 
it is a general disease, primarily affecting every function of 
the body, are fallacious ; — and that when strictly examined, 
it will be found, that all general or extensive derangements 
of the system, are referable to local disease in one organ. 
''Fever, in regard to its effects on the system/' says he, "is 
the most general of all diseases, and gives rise during its pro- 
gress, to the greatest variety of symptoms ; but its first ap- 
pearance accurately noticed, will be found to be strictly a 
topical affection j the general disorder of the system being 
merely secondary or symptomatic of this." In another work 
he says " that all the varieties of idiopathic fever, which 
differ but in degree, as well as those which arise from specific 



ETC. 

contagion, as malignant sore throat, scarlet fever, small pox, 
and so on, arise from one and the same affection, of one and 
the same organ, and that affection consists essentially in in- 
flammation." 

Broussais taught a similar doctrine. According to him, all 
r - fevers are of the same nature ; those termed malignant, 
differing from other fevers, only, by the violence and danger 
of their congestions ; all the causes of fever act locally." 

" Considered in a general and abstract maimer, fever is 
invariably the result of a primitive or sympathetic irritation 
of the heart, through the effect of which, its contractions are 
quickened : and every irritation, sufficiently intense to pro- 
duce fever, is an inflammation." 

Respecting the nature of fever, there is a perfect accord- 
ance between the doctrines of Clutterbuck and Broussais. 
Both are agreed, that it is an affection of the solids of the 
body; and that its essence consists in inflammation. Both 
are agreed, that the inflammation is strictly local, being 
seated in one organ. But in determining what that organ is, 
there is an entire discrepancy in their opinions. According 
to Dr. Clutterbuck, ' : the organ invariably affected, in every 
variety of idiopathic fever, is the brain. He considers it to 
be a species of phrenitis, and that it might be arranged in the 
order phlegmasia?, with pleurisy, enteritis and other sympto- 
matic fevers ; but that, since the term phrenitis has been ge- 
nerally applied to a particular form of inflammation of the 
brain, and implies delirium, which does not always occur in 
fever, although it is a frequent symptom; encephalitis, would 
form a proper denomination for this entire class of diseases, 
and might be substituted for the term, fever." 

Broussais contends, that the primary and essential seat of 
inflammation in fever, is the mucous membrane of the stom- 
ach or of the intestines, or both ; but essentially the former, 
and that, therefore, '-the proper designation of fever, is gas- 
tro-enteritis." 



THEORIES OF EEVER, ETC. 75 

These different and opposite theories of fever, are found to 
have a most important influence on the practice recommended 
by their respective authors, in the treatment of the disease. 
The advocates of debility, deprecate all active interference ; 
the grand evil to be contended with, is debility. "The 
physician can easily weaken, but he cannot easily strengthen. 
Of course every kind and every degree of depletion that can 
add to the primary cause of the malady, must be abstained 
from, with the utmost caution." 

The advocates of inflammation state explicitly, that the 
remedy of the disease is one, and in point of importance one 
only; which is admitted by all to be the only efficacious one 
in the treatment of inflammation. " Fever, to be treated 
successfully," says Dr. Clutterbuck, "must be treated upon 
the general principles of inflammation ; but at the same time 
with the modifications arising out of the peculiar nature of 
the organ affected, and in some degree also, the nature of the 
exciting cause : Blood-letting is proved by ample testimony 
to be, not only the most powerful, but the safest of reme- 
dies." And according to Broussais, in every variety of fever, 
and in all its stages, leeches are to be applied to the stomach, 
and scarcely any thing else is to be done, except enjoining 
rigid starvation. 

Of all the theorists which we have noticed, we consider 
Clutterbuck entitled to precedence. His views will be more 
extensively considered in the sequel ; when with all due de- 
ference, we will show some points in which he is deficient. 
In so doing, he will excuse us, for he says, " it becomes a 
duty, incumbent on those particularly, who have been placed 
in situations favorable for observing the disease, to give the 
result of their experience to the public ; should it tend in 
any degree, either to prevention or cure. The inquiry is by 
no means exhausted, considered either in a theoretical or a 
practical point of view. There is still a want of uniformity 
of opinion among physicians, regarding the nature of fever 



76 THEORIES OF FEVER, ETC. 

in general, and the modifications of treatment necessary in 
different circumstances. To ascertain these modifications, is 
the great desideratum, which nothing but the most cautious 
observation, aided by much time, and the joint efforts of nu- 
merous individuals, can supply." We bring with us, the 
proceeds of a considerable practice, extended through a term 
of half a century, and offer them as our contribution to the 
common stock. 

Dr. Southwood Smith, has contributed a highly respecta- 
ble treatise, which is an approximation to truth, and it is 
believed that we will cheerfully be indulged in making some 
extracts from his work. " On careful examination," says he, 
<■'- it will be found, that the first symptom which denotes the 
commencement of the ordinary fever of this country, in its 
mildest form, is a loss of mental energy. This is, however, 
by no means the first symptom which attracts attention : it 
is commonly overlooked for some time and excites but little 
notice, until it has become distressing." i: This affection of 
the mind consists, particularly, in indistinctness and conse- 
quent confusion in the train of ideas ; in an inability to 
attend to their relations, and therefore in the loss of power 
to think clearly. The patient is conscious of inability to 
form a sound judgment on any subject." This is the condi- 
tion of the sensorium, when fever is in its incipient state. 
Cullen considered this symptom, which he says is a diminu- 
tion of the energy of the brain, to be produced by the excit- 
ing cause of fever. What then is the exciting cause ?. Our 
elementary principles will furnish us with the answer. The 
external capillaries have been brought into the condition of 
atony: the skin is more or less constricted, and the arterial 
structures are injected. The portion of the aorta from the 
heart to the innominata, and the continuation of the innom- 
inata to the carotids, constitute a very direct passage for the 
blood to the head. Consequently when the arterial struc- 
tures generally are in a tense state, those of the head will be 



THEORIES OF FEVER, ETC. 77 



more particularly incommoded j the course of the blood, from 
the heart to the head is so direct, and the distance is so short. 
We answer then, too great pressure made upon the brain 
by an injected state of the arteries, is the exciting cause, 
which affects the mind, after the manner above described. 
General attention ought to be invited to this symptom. It 
ought to be a warning voice to every person, when first felt ; 
for a sufficient blood-letting employed at this stage, will al- 
most invariably prevent a fever. The statement here made, 
is strictly true in regard to the stress imposed on the brain, 
and in a majority of instances in healthful climates, the effi- 
cacy of blood-letting would be as decisive and effectual, as it is 
here declared to be. The doctrine, however, needs qualifi- 
cation. In sickly districts, very often, and sometimes in re- 
gions known to be healthful, concurring circumstances, so 
completely cripple the capillary vessels of the surface ; insti- 
tute such a degree of atony in those structures, that the addi- 
tional direct debility set up by blood-letting deprives the sys- 
tem of ability to react ; which in many cases would be fatal. 
It follows, that the physician should keep this qualified ex- 
ception in view. More will be found on this subject, in an- 
other place. 

" Closely connected with this mental weakness, is the loss 
of energy in the muscles of voluntary motion ; great lassi- 
tude ; a distressing sense of weariness, even in a sitting pos- 
ture." These sensations are additional evidences of contin- 
ued pressure on the brain, and indicate the increasing neces- 
sity of depletion. 

The next symptom in the order of succession, and which 
is still more characteristic of tension, tending to a state of ir- 
ritation of the meninges, consists in an uneasy sensation, 
commonly called restlessness, which is even more distressing 
than pain. Dr. Smith calls it "febrile uneasiness." 

These symptoms are soon followed by pain, first in the 
back and loins, and then in the limbs. The patient looks 



7S 

dejected, as if worn down by fatigue ; his face is pallid and 
his features somewhat shrunk. These appearances indicate 
a tense condition of the capillaries of the spinal chord, cor- 
responding to that of the meninges, and calling loudly for 
blood-letting from the arm, or cupping over the spine, or 
both. The skin becomes exceedingly sensitive ; ordinary 
degrees of temperature produces a sensation of cold, which 
is sometimes intolerable. Chilliness is felt even in a heated 
room or a warm bed, increasing to shivering. But this feel- 
ing of chilliness, does not depend on external temperature ; it 
is increased by cold, but it exists in spite of external heat. 
Doctor Smith says, " while the patient experiences the sen- 
sation of cold, there is no diminution of the quantity of calo- 
ric in the system. The thermometer applied to any part of 
the body, commonly rises as high as in a state of health, and 
the skin touched by the hand of another person, communi- 
cates, not the feeling of cold, but often on the contrary, that 
of preternatural heat. There is no positive abstraction of 
caloric from the body, nor any failure of the process, what- 
ever it be, by which animal heat is generated ; there is 
only altered sensation in consequence of derangement in 
the functions of the skin.* In this form of fever, the chil- 
liness, in many cases, never amounts to shivering ; in 
others there is an attack of well marked rigor ; and in others 
again, there is no feeling of cold, or it is so slight, it escapes 
observation." 

The excitement of the capillaries of the skin is so dimin- 
ished, that for an indefinite length of time, its vitality is in- 
creased, accompanied by an increased sensibility to cold ; and 
a warm room, or a warm bed, will not correct its morbid 
sensation, until the returning circulation of the blood restores 
its natural state. 

The superficial heat, which acts on the thermometer, and 

* In this the Doctor errs. See our elementary remarks on vital heat. 



THEORIES OF FEVER, ETC. 79 

may be felt by the hand of another person, is the consequence 
of deficient perspiration. Excitement is below the natural 
state, and caloric is therefore imperfectly developed. But in 
the absence of the necessary moisture, it cannot escape, and 
therefore accumulates on the surface. If at this stage, the 
patient be bled sufficiently, and the depletion be immediate- 
ly followed by an application of external heat, a pleasant per- 
spiration will be readily established, and all the morbid ap- 
pearances will retire. 

The symptoms thus far enumerated, are all referrable to 
derangement of the functions of the brain and spinal chord, 
and this derangement is consequent on excessive tension 
in the arterial structures, pertaining to those two important 
organs. 

About this stage, however, the circulating system is be- 
ginning to exhibit a participation in the morbid action. The 
pulse expresses langour, and commonly becomes more fre- 
quent, sometimes it is slower, but invariably weaker, than it 
is in health. The respiration is shorter and quicker than 
natural. The chest fails to expand freely, and seeks com- 
pensation in an additional number of respirations. 

There is great uncertainty, as to the time which may in- 
tervene, between the symptoms indicating the impression 
made on the sensorium, and those which evince a disturbed 
condition of the thoracic viscera; commonly, the more 
acute the shorter the period, but not always. Cases 
occur, which are slow in forming, and for a while, do not 
excite alarm ; but ultimately, become formidable, or even fa- 
tal. All such variations as to time, depend on the ability of 
the distended vessels to defer a state of irritation. At length 
however, the retarded blood, by detention becomes deterio- 
rated, till it is sufficiently stimnlant to excite and establish a 
state of irritation. Then the pulse, which was feebler than 
natural, becomes more full and strong, and generally more 
frequent than in the healthy state ; and the skin, which was 



80 THEORIES OF FEVER, ETC. 



cold, becomes preternaturally hot, rising from 98°, the natu- 
ral standard, to 105° Farenheit. x 

" When the circulation becomes thus excited, the func- 
tions of secretion and excretion become deranged. The 
mouth is dry and parched ; the tongue begins to be covered 
with fur ; thirst increases, and the secretions of the liver, 
pancreas, and mucous membrane lining the alimentary ca- 
nal, are all vitiated; the urine is altered in its appearance; 
and the skin becomes hot, dry and harsh to the touch. 
Meanwhile, the pain in the back and limbs, and the febrile 
uneasiness are increased. It may be said, the fever is now 
fully formed. 

Take a summary review of the subject. The external ca- 
pillaries, in consequence of debility, are impaired ; their func- 
tions partially suspended : the circulation impeded at the ex- 
tremities of the arterial structures ; the whole arterial sys- 
tem becomes injected to a state of distention ; the stress im- 
posed on the blood-vessels of the head has impaired the func- 
tions of the sensorium, and of the nerves ; the blood making 
organs have lost their activity ; although the arteries are in- 
jected to excessive fulness, the veins are emptied into the 
yielding vessels of the viscera. The viscera decrepid and 
overburthened, cannot* perform the function of assimilation. 
A deterioration of the blood becomes inevitable, which of 
course must continue to increase, until the entire train of ir- 
ritations which constitute fever is established. All this might 
be prevented by one well-timed and sufficient blood-letting. 
But when fever is established, the irritations which consti- 
tute it, are inflammatory in their nature and tendencies, and 
require a treatment according to the views of Clutterbuck 
and Broussais ; giving preference to the doctrines of the for- 
mer, in treating a case of sensorial or thoracic irritation : and 
to those of the latter, when the irritation shall be gastro- 
interetic. 



BLOOD-LETTING, ETC. 81 



CHAPTER YI. 

BLOOD-LETTING, A MOST IMPORTANT REMEDY IN THE 
TREATMENT OF FEVER.. 

According to the views which have been submitted, it 
will appear that blood-letting is a remedy of the first impor- 
tance, in the treatment of fever ; the superiority of " which, 
in comparison with other means of cure," says Dr. Clutter- 
buck, " is shewn in various respects. It is a remedy most 
frequently called for in general practice, and often, of itself, 
without the aid of other means, accomplishes all we wish. 
In point of efficiency, none will bear a comparison with it, 
while it is one, for which, on numerous occasions, no ade- 
quate substitute can be found. It is prompt in its effect, so 
as to be adapted to many cases of great and sudden emer- 
gency. It is the least equivocal of remedies. Its good ef- 
fects, when properly administered, are in most cases so im- 
mediate and striking, as not to be mistaken. This can with 
truth be said of few others of our curative means ; which, 
except with regard to those of the simplest operation, seldom 
accomplish what they are supposed to do. In short, blood- 
letting is a remedy j which when judiciously employed, it is 
hardly possible to estimate too highly. There are indeed 
few diseases in which, at some period, and under some cir- 
cumstances, it may not be used with advantage,, either as a 
palliative, or curative means. A great number of diseases are 
speedily brought to a termination by the early use of this re- 
medy, which without it, are apt to run a protracted course ; 
thereby, inflicting much and unnecessary suffering on the 
patient. On various occasions, life is brought into immediate 
hazard by the neglect of this essential means; and still 
6 



S2 BLOOD-LETTING, ETC. * 

oftener does it happen, that by such neglect, a foundation is 
laid for chronic maladies of difficult descriptions, which are 
not less fatal in their result ; such as pulmonary consump- 
tion, dropsy, and confirmed asthma. But blood-letting more 
than any remedy, requires to be well-timed." 

In all this report of the value and importance of blood- 
letting, Dr. Clutterbuck has the confirmation of our observa- 
tion and experience, carefully conducted for the term of 
fifty years. " From the earliest times, this remedy has been 
extensively employed ; and at no period has it been held in 
higher estimation, or more frequently resorted to, than in the 
present day; one might naturally expect, therefore, that a 
pretty general agreement in opinion would be formed among 
practitioners, with regard to it. This, however, is far from 
being the case. Opinions are still vague and unsettled upon 
the subject ; and in some respects contradictory; while the 
merits of the practice are by no means justly or sufficiently 
appreciated. I know of no greater service that could be ren- 
dered to the healing art, and consequently to society at 
large, than the assigning with tolerable certainty and precis- 
ion, the various circumstances that ought to influence us, in 
the use of this herculean remedy. The task of doing this, 
however, is of no ordinary kind, and as I believe, not to be 
perfectly accomplished by any individual. Every contribu- 
tion will therefore be willingly received." 

The following facts, which we have many times observed, 
are all sustained by the observations of Dr. Clutterbuck : 
When blood is drawn from any large vessel, either vein or 
artery, to a certain amount, and with a certain degree of ve- 
locity, the loss is followed by a number of changes in the 
system, which vary according to the quantity lost, the ra- 
pidity with which it is taken and the particular state of the 
individual at the time, in regard to strength, age and other 
circumstances. These changes may be divided into the 
primary or immediate, and the secondary or more remote. 



BLOOD-LETTING, ETC. §3 



This distinction is necessary in a practical point of view, as 
we are sometimes desirous of obtaining the primary, some- 
times the secondary or remote effects of the evacuation. 

"In adults of ordinary bulk, and at the middle period of 
life, the abstraction of six or eight ounces of blood, from a 
vein, slowly and quietly, as in ordinary venesection, produces 
commonly no striking or obvious effect, nor generally speak- 
ing, any that is perceptible afterwards; neither the feelings, 
nor any of /the functions are sensibly disturbed or impaired 
by it. But if the evacuation be carried to twelve, sixteen or 
twenty or thirty-six ounces, or if a smaller quantity be taken 
away rapidly, then greater and important changes generally 
ensue, and which take place in a somewhat regular order as 
percepfable in the state of the different functions of the body 
and mind." « There is commonly first experienced, a slight 
feeling of langor; and if the pulse at the wrist be examined 
it wfil be found to beat more freely, and often more slowly 
than before; though sometimes the reverse of this takes 
place. Breathing also becomes slower, in conformity with 
the pulse, and it is often irregular, with deep sighs. If the 
flow of blood goes on, the languor increases, the pulse becomes 
still more feeble, and sometimes fluttering. To these suc- 
ceed paleness and coldness of the skin and shrinking of the 
features; cold drops of sweat hang on the forehead, and 
sometimes perspiration breaks out over the whole surface • 
tfe eyes look glassy and the pupils are dilated. Occasionally 
also, there is vomiting with other involuntary discharges 
and m a few instances epileptic, or convulsive movements 
more or less general, take place. The pulse at last is not to 
be felt, the respiration ceases, and consciousness is wholly 
lost. Tins is the state termed syncope or fainting ; ferine 
which if complete, there is in appearance, an entire suspen- 
sion of all the vital movements, morbid as well as healthy 
it is in fact, a state of apparent death. These effects seldom 
continue longer than a few minutes, rarely for half an hour • 



g£ BLOOD-LE.TTINS, ETC 



w hen the pulse again begins to be felt at the wrist, respiration 
is renewed, often accompanied with yawning; and con- 
sciousness returns."' 

« Sometimes a copious bleeding is followed by a throbbing 
head-ache, and a sleepless. night." Dr. Clntterbuck considers 
that these last two circumstances go to show, that, not 
only the vascular action of the brain, but its function! * also 
have been disturbed by the evacuation. Such throbbing 
head-ache, however, is not likely to befall any, but such as 
are of a nenrous temperament, and direct debility is the cause 
of it and of the sleepless night which follows depletion m 
such cases. Robust patients only, can safely be bled so de- 

ClS ' When the primary and temporary effects above described 
have gone off, if the quantity shall have been considerable 
as a pLid or two or more, there will sometimes follow n 
only a feeling of languor, but actual weakness The pulse 
will be smalf and feeble and there will be inability to make 
voluntary exertions.. If the loss shall have been very large, 
In a violent hemorrhage, or if the blood shall have been 
largely and frequently drawn, which violent inflammation 
ometLs requires, the weakness which •JJ^JL^ 
proportion :tp. the quantity of blood lost, and is often veiy 
Liable.. The skin remains pale and bloodless in appearance, 
for many months ; there is a great languor or feeling of weak- 
ness, and an imperfect performance of the &"*; J h f 
la.tmay commonly be remedied by proper management as. 
tureen in the sequel. The effects of blood-leUmg, 
however are by no means, in a strict and uniform accoid- 
ancTS the quantity drawn,, or the rapidity with which it 
Td s hted horn the vessels. The bulk of the patient, his 
r it D and age, have a share in modifying the resu t 
Temperament, climate, manner of life, &c., are all to be 

"^od-ttnns makes the most hnmediate impression on 



BLOOD-LETTING, ETC. 



the heart and blood-vessels, the condition and action of 
which, it can control more effectually and permanently, per- 
haps, than most other medicinal agents. This is an impor- 
tant fact, since the most violent and fatal diseases, and those 
too, of the most frequent occurrence, are seated essentially in 
this class of organs. Such are fevers and inflammation of 
all kinds, in which the action of the heart and arteries, and 
in consequence the circulation of the blood, are always more 
or less disturbed. But the effect will be different, according 
to the degree of irritability of those structures. 

Blood-letting has no doubt been sometimes resorted to, 
where it was not absolutely necessary, and in cases which 
-might have done well without it j but much more frequently 
it has been withheld, when its use would have been fol- 
lowed, by great and decisive benefits. And it is often em- 
ployed without being well timed, and without correct judg- 
ment, in respect to quantity, repetition, and manner of draw- 
ing. We approve the doctrines of Clutterbuck and Brous- 
sais, so far as to admit, that all fevers are more or less inflam- 
matory in their essential characters and effects ; and of 
-course that abstraction of blood is often very necessary in the 
treatment of fever. . 



86 CONTINUATION OF REMARKS ON BLOOD-LETTING. 

■ ■ -m — — 

CHAPTER VII. 
CONTINUATION OF REMARKS ON BLOOD-LETTING. 

Agreeably to Dr. Clutterbuck the various opinions of phy- 
sicians, as to the manner how blood-letting acts in the re- 
moval of disease, may be reduced to the following heads : 

That it acts upon the principle of depletion j in other 
words by diminishing the general mass of the blood. 

Or simply and altogether by weakening the system. 

Or as a sedative diminishing vascular action ; this in a 
great number of diseases being in excess. 

The first of these opinions is formed on the supposition, 
that there is often a superabundance of blood in the system, 
constituting what is called a plethora ; and that such a state 
of fullness is the cause of inconvenience and danger. That 
it impedes the circulation by its too great volume, and may 
produce mischief by distension. But Dr. Clutterbuck con- 
siders the existence of plethora questionable, and that the 
signs usually pointed out as proof of its existence, are at best 
equivocal. That the relief afforded by blood-letting ought 
to be ascribed to depletion merely, as being effectual to di- 
minish arterial action, and that the effects which have been 
ascribed to depletion, ought to be set down to the account of 
reaction, as if the consequence of over-stimulation. 

The second opinion, " that blood-letting acts by weaken- 
ing the system only," is based on the doctrine of the sthenic 
and asthenic diathesis. But the same author says " diseases 
neither consist essentially in, nor are derived from, excess of 
vigor in the system at large. We do not deny that weak- 
ening the general system, whether it be effected by blood- 
letting or any other means, conduces at times and under cer- 

* In this Dr. Clutterbuck errs. 



CONTINUATION OF REMARKS ON BLOOD-LETTING. 87 

tain circumstances, to the removal of disease and especially 
where the habit is strong ; but the same remedy is often 
equally effectual for its purpose, when the body is already 
weak. In both cases, the remedy is uncertain in its effect, 
and frequently fails to cure. This would seem to show, that 
it is not simply by inducing weakness that the object is at- 
tained ; but in some less direct way, probably lessening the 
disposition to disease." 

As to the last opinion, that blood-letting acts by a sedative 
operation, that is, by diminishing vascular action without 
regard to the general strength, "a great number of diseases 
in which this remedy is found useful, are accompanied by 
much vascular excitement ; such is the case in febrile diseases 
in general. But sueh diseases do not consist simply in in- 
creased vascular action, nor do they yield with any thing like 
certainty, to this or any other sedative remedy. Blood-let- 
ting is not required in all cases in which vascular action is in 
excess, on the contrary equally good effects are often found 
to result from remedies of a totally different nature." He 
infers from the whole, " that it is not as an evacuant merely; 
nor by lessening tension ; nor merely by weakening the sys- 
tem nor by a sedative operation on the vascular system that 
blood-letting effects our purpose in the removal of disease. 
The most intelligible explanation of the matter appears to be 
this ; that by any considerable loss of blood, however occa- 
sioned, a kind of shock is given to the system, in conse- 
quence of which, all vital movements, morbid as well as 
healthy, are more or less disturbed. In this respect therefore, 
blood-letting resembles in its effects, other sudden and pow- 
erful impressions on the system, whether made on the mind 
or body, and whatever be the cause producing them. In short, 
blood-letting, in checking or suppressing violent disease of 
any kind, appears to act upon a principle very analagous to ? 
or identical with, what is called counter-irritation, but which 
in this case is perhaps better termed counter-impression," 



SS CONTINUATION OF REMARKS ON BLOOD-LETTING. 

" Upon the principle now stated, namely, that of counter- 
impression, there is no difficulty in comprehending the supe- 
riority of venesection, in most instances, over the slower 
modes of drawing blood by leeches or scarificatisn and cup- 
ping ; and we at the same time, readily understand, why the 
same remedy should prove effectual for the removal of so 
many various forms of disease, as is found to be the case." 
But blood-letting is not always advisable for the purpose of 
producing counter-irritation. Weakness of the patient may 
forbid it ; whilst in cases, under circumstances to which the 
remedy is well adapted, it is far more efficacious than the 
other modes of producing counter-irritation usually resorted 
to, such as blistering, the use of mercury, and the like, and it 
is free from any serious inconvenience to which these are 
liable and which are often such as to render them wholly 
inexpedient. 

Let it be repeated, that in the forming state of fever, the 
external capillary structures are in a state of debility, failing 
to perform their functions ; the skin is constricted more or 
less tightly around the whole body; the circulation is im- 
peded at the extremities of the arterial structures ; the 
returning circulation by the veins and lymphatics is acceler- 
ated by the constriction, which simultaneously resists that of 
the arteries ; and whilst the arteries are injected to a state of 
tension and likely to be fretted to irritation, the viscera are 
burthened with an introversion of the fluids, by which those 
organs are so much oppressed as to be disabled to perform their 
functions ; the visceral secretions are diminished, of course 
much excrementitious material is detained ; the effete matter 
which ought to pass off by perspiration is also retained, possi- 
bly to the amount of two or more pounds in a day. Hence it 
inevitably follows, that in the commencement of fever, the sys- 
tem is in a plethoric state j Dr. Clutterbuck's opinion to the 
contrary notwithstanding. Blood-letting is therefore almost 
invariably useful, and in a large proportion of instances abso- 



CONTINUATION OF REMARKS ON BLOOD-LETTING. 89 

iutely indispensable. By a copious depletion the advantage 
of the Doctor's shock is gained — the injected condition of 
the arteries is retired ; the oppression of the sensorium is re- 
moved ; the volume of the circulating fluids is brought within 
the compass of functional agency, so that they may be re- 
fitted for use j and preparation is made for a general restora- 
tion of order. 

But in many instances plethora exists until the blood it- 
self is vitiated. To extract a portion of it. therefore, in a man- 
ner the most direct possible, must lessen the cause of morbid 
action. Under these circumstances, Dr. Rush was of opinion, 
that the effect of blood-letting was as immediate and natural 
in removing fever, as the abstraction of a particle of sand is 
to cure the inflammation of the eye when produced by it. 
Of course, in all cases, especially when there is much pain 
and the condition of the patient will admit of speedy evacu- 
ation, it will be better to commence with blood-letting.* 

It may be performed in a manner so decisively effectual, as 
to strangle fever in its forming state. And this can always 
be done, if used with the necessary decision, before general 
irritation or local congestion, shall have been established. 
By reducing the quantity of blood to a volume, which the 
system can command with ease, the circulation becomes 
free and pleasant, the organs concerned in its elaboration, are 
regularly employed, and a speedy return to order is establish- 
ed throughout the whole system. In this way, it often hap- 
pens, that a very alarming sense of debility is removed at 
once by bleeding, with or without auxiliary evacuations. In 
the same manner, when the pulse is uncommonly frequent 
because of a fullness of the arterial system ; by blood-letting, 
the thraldom of the heart is removed and the pulse assumes 
a regular motion. So also, when the pulse is preternaturally 

* However, care must be taken, to place the superficial vessels in a condi- 
tion to secure reaction. The ways and means for accomplishing this will be 
submitted in their proper places. 



90 CONTINUATION OF REMARKS ON BLOOD-LETTING. 

slow, whether it be the effect of too great fullness of the ves- 
sels of the head, or of the vena porta and liver, by the loss of 
blood, the motion of the heart — that is, the circulation of the 
blood is accelerated. 

Having mentioned the fullness of the liver and portal cir- 
culation, we must observe, that when there is a great nausea 
and vomiting from that cause, very often, blood-letting af- 
fords immediate relief; and in all cases when the state of the 
pulse will warrant it, the same remedy will correct or pre- 
vent, that kind of diarrhoea which attends on eruptive dis- 
ease, or other inflammatory affections. 

When the secretions are imperfectly performed or locked 
up, blood-letting very often in a short time sets them at lib- 
erty. In obstinate constipation of the bowels, with or with- 
out known inflammatory appearances, cathartics seldom 
prove effectual, until preceded by copious blood-letting. If 
the blood vessels of the intestines are much distended by ar- 
terial stress, the irritation of gamboge united with calomel, 
will not be sufficient to excite catharsis. So also in the ad- 
ministration of mercury, ptyalism will not be produced, until 
the arterial system is first sufficiently relaxed. The same 
remark will apply to an attempt to produce diaphoresis, when 
there is too much inflammatory action. The effort will be 
ineffectual, whether the attempt be made by the administra- 
tion of nauseating medicines, diluting diaphoretics, or by the 
application of external heat, until the blood vessels are first 
reduced to a suitable condition. A deficiency in the secre- 
tion of the juices of the mouth and fauces, when consequent 
on too much fullness or tension of the arterial system, will 
not be corrected by any kind of drink or wash, till the con- 
dition of the vascular system shall have been rectified, by 
blood-letting or other equivalent evacuations. 

A hot skin, when consequent on that kind of violent ex- 
citement which is common in cases of pleurisy or pulmonitis, 
when it occurs in persons of vigorous constitutions ; as also iix 



CONTINUATION OF REMARKS ON BLOOD-LETTING. 91 

many instances at the commencement of malignant fever, is 
immediately cooled by sufficient loss of blood ; as also, a sen- 
sation of burning which is felt in the stomach in some alarm- 
ing cases of bilious fever. In this last symptom, however, 
some special precautions are to be regarded in the employ- 
ment of blood-letting, which will be noticed in their proper 
places. There sometimes occurs in bilious fever, a peculiar 
kind of protracted chilliness, continuing for several days, and 
which refuses to yield to any ordinary management, not even 
to the employment of internal or external heat, but which re- 
tires immediately on sufficient blood-letting. A case of this 
sort requires diligent investigation, as it universally implies 
congestion in some important viscus ; and of course, an undue 
attempt to insure warmth by the use of cordial or stimulating 
draughts, must have a tendency to produce incorrigible mis- 
chief. 

Sometimes, by an unaccountable aberration of sensorial in- 
fluence, the arterial capillary action of the skin becomes mor- 
bid, effecting such excessive secretions of sweat, as to threat- 
en fatal prostration, and at the same time the perspiration, 
however profuse, affords no relief to the painful symptoms. 
Blood-letting subdues the arterial action, and the absorbents 
resume their natural functions. Under a similar state of 
things, although less general, we sometimes meet a profuse 
sweat of the head and chest. This in like manner is correct- 
ed by timely blood-letting. In a case of this kind, however, 
caution is necessary, inasmuch as it is more likely to occur at 
a later stage of the fever, when there may be too great debil- 
ity to admit of blood-letting. In any instance, when diar- 
rhoea or tenesmus occurs in the course of bilious fever> unless 
there be too much debility, they are most certainly corrected 
by blood-letting, or leeching, or cupping. And in any case 
in which it might be supposed, that these were consequent 
on debility, if they should resist the use of opium and astrin- 
gents, and especially if the patient have been sufficiently blis- 



92 CONTINUATION OE REMARKS ON BLOOD-LETTING, 

tered, there will be a tense state of the pulse, which ought 
to have been regarded at the first, as indicative of the neces- 
sity of blood-letting. Coma, seldom, if ever, occurs in any 
instance of fever which has been timely treated with suffi- 
cient depletion by the lancet ; and blood-letting, cupping or 
leeching, when necessary, is the best — the only anodyne, in 
cases of febrile restlessness. 

Dr. Rush was of opinion, that the frequent instances of ef- 
fusion of serum and of blood, which have occurred towards 
the conclusion of fevers, when treated with diaphoretics and 
imperfect evacuations, might have been prevented in almost 
every case, by sufficient blood-letting ; and many instances 
of the most troublesome coughs, consumptions, asthmas, jaun- 
dice, abscess of the liver, and all the different forms of drop- 
sy, which so often follow autumnal fevers, are consequent on 
deficient blood-letting in their early stages. 

Fifty years ago we often heard much about putrid or gan- 
grenous fever. But having been an early advocate for a lib- 
eral use of the lancet, we have rarely seen an instance of that 
sort, during the half century of our practice. Dr. Morton, in 
1678, described a putrid fever which was epidemic and fatal. 
Dr. Sydenham, who practised in London at the same time, 
appears to have taken no notice of it. Dr. Sydenham used 
his lancet freely. Dr. Morton pursued another course. The 
result was, the one had to witness great and fatal congestion, 
the other saw nothing of that distressing condition. Hav- 
ing mentioned a variety of instances and circumstances in 
which it is useful and necessary to have recourse to blood- 
letting, we wish it to be understood, that in all of these, the 
remedy has been considered in reference to general principles 
only, and that there are many precautions, which in their 
places will be submitted. 



9a 



CHAPTER YIII. 

PREJUDICES AGAINST BLOOD-LETTING MET AND COR- 
' RECTED. 

There are some erroneous opinions and prejudices, enter- 
tained in opposition to the use of the lancet, which need to 
be removed out of the way, and which claim our attention. 
We were once sent for by a German, to visit his daughter,, 
who ha'd been eight or ten days ill with an inflammatory af- 
fection of the lungs. On our arrival, he let us know, that he 
would have sent more than a week earlier, only, that he was 
persuaded that his daughter's disease was a pleurisy, and 
that it would be considered necessary to let blood. He had 
therefore waited to see if she would live through the dog days, 
which she had done,, and if we thought fit, she might now 
be bled. It was too late, she died on the following day. 
There are many who think it hazardous to bleed in very hot 
weather. We are informed that Galen bled in a plague, and 
Aroeteus, in a bilious fever, in a warm climate. According 
to Dr. Sydenham and Dr. Hillary, the most inflammatory fe- 
vers occur, and succeed to hot weather. It was the practice 
of Dr. Cleghorn in the warm months, in the Island of Mi- 
norca. Dr.. Mosely, treated yellow fever successfully by 
blood-letting in the Island of Jamaica. The same practice 
has been followed in that Island by other physicians, particu- 
larly by Dr. Broadbelt and Dr.. Weston. It has been found 
to be successful in St. Domingo, and there is high authority 
in proof, that it is the practice of the native physicians of 
Upper Egypt. We have used the remedy as fearlessly, and 
with as decided effect, in summer as iri winter or spring. It 



0,4 PREJUDICES AGAINST BLOOD-LETXliNu, Mu, 

is true, it is not so generally necessary, nor do cases common- 
ly require as many repetitions, in the summer season as in 
cold weather ; and more attention is necessary to insure re- 
action after the operation. 

Another prevailing prejudice with some, is, that the natives 
of the West Indies, or other warm climates, cannot safely 
use the remedy. If the natives of such climates inherit ir- 
ritable constitutions, the remedy will be the more necessary 
for them in any and all cases of inflammatory disease, which 
may befall them. If not, then of course they have no more 
to fear than other people. 

We often find a difficulty in gaining the consent of patients 
to be bled, when they feel themselves weak. It is almost 
impossible to make uninformed persons understand the na- 
ture of indirect debility. We commonly state in few words, 
your system is too full to perform its motions and functions 
with the necessary ease ; you therefore feel weak. By evacua- 
tion, the vessels will be set at liberty, and you will feel stron- 
ger upon loss of blood. Ordinary confidence on the part of 
the patient, supported by some such attempt at explanation, 
generally insures consent. It would be well to be able to 
add to this reasoning, when necessary, that if there be a 
great sense of weakness, in consequence of too great fulness, 
other remedies, whose effects are dependent on the functions 
of the viscera, will prove ineffectual, and time will be lost. 
In a case of this sort, all the time we are waiting, there is 
an increase of mischief and danger attendant on the disease. 

The greatest objections are ordinarily made, however, 
when it is found necessary to bleed persons of very delicate 
constitutions ; and especially if for a long time, they have 
been in a state of debility. Persons of such temperament and 
habits, are subject to the same kind of morbid action of the 
vascular system, which destroys the organs of more robust 
patients. Although there may be less arterial force, there is 
a corresponding irritability of the blood vessels. In fact, per- 



PREJUDICES AGAINST BLOOD-LETTING, ETC. 95 

sons Having very delicate vital organs, commonly require lar- 
ger bleedings in proportion to apparent strength, than those 
more robust. Such patients and their friends, too often in- 
sist on th£ use of emetics, purges, sweats, $*c. in preference 
to blood-letting. The physician, therefore will find it ne- 
cessary, in many instances, to condescend to the use of an ar- 
gument, and persevere in it, until he shall have succeeded in 
removing their prejudices. And if he act discreetly, it will 
commonly follow, that the speedy diminution of the alarm- 
ing symptoms, and the unexpected comfort, which follow the 
use of the lancet, when skilfully employed, will ever after- 
wards make his way sufficiently easy. Our patients of this 
description, are, without a single exception, the greatest 
friends to the Mood-letting practice. 

We have often to encounter other prejudices against the 
use of blood-letting in instances of infants and young chil- 
dren. We shall have occasion to state in another chapter, 
that the remedy when required in children's cases, may be 
commonly considered to be imperiously necessary. The 
great irritability of their blood vessels, the difficulty of using 
other remedies to equal advantage, and especially the danger 
which awaits them in inflammatory affections of the lungs 
and head, to which they are particularly liable, make it ne- 
cessary that the use of the lancet in such cases should be em- 
phatically insisted on. Mothers and nurses often raise objec- 
tions ; we commonly succeed with them, by letting them 
feel, that we shall hold them responsible for the issue, if they 
take upon them the attitude of opposition, in a case where 
the practice is necessary. 

It is another mistake equally great, that old people cannot 
be bled. The relaxation of their blood vessels makes them 
liable to plethora, especially when they have pretty good 
health ; for such ordinarily experience an increase of appe- 
tite, as their age advances. We knew an old man of eighty, 
who let blood largely at certain stated periods. He was usil- 



96 PREJUDICES AGAINST BLOOD-LETTING, ETC. 

ally bled twenty-four ounces at a time. Another, a Scotch 
labourer, a ditcher, who could earn wages at the age of eighty- 
four years, was also accustomed to the same practice. There 
was a lady in our city, about eighty-five years ojd, whom 
we bled largely, on frequent occasions of her illness. In 
1S26, we bled every patient, old or young, who was affect- 
ed with an inflammatory influenza, which was then epidemic^ 
except one old lady of ninety. We wished to bleed her al- 
so, but she and her friends declined it, on account of her age. 
She was relieved in the course of five or six weeks, by fre- 
quent and gentle cathartics. She might have been cured in 
six days. Botallus, physician to Henry III of France, who 
wrote a treatise, De Cur. per Sang. Mission, 1660, says, 
" majus esse adjuvandos senes missione sangukiis, dum mor- 
bus postulat, aut corporum eorum habitus malus est, quam 
ubi haec juvenibus contingent,"* of course we see, that the 
practice is not new, and to judge by what has very often 
come under our own observation, a sufficient experience in 
the practice of blood-letting will lead any judicious practi- 
tioner to use the remedy as fearlessly in cases of old patients 
as of those that are young. 

It is one of the most common prejudices, that blood-letting 
is inadmissible in time of menstruation. But the uterus, is 
always during the continuance of that state of things, in an 
irritable condition, the system is plethoric, and any incon- 
siderable exciting cause, frequently produces violent degrees 
of irritation. There can be no quesli3ii therefore, that in ca- 
ses of fever in such circumstances, blood-letting is more ne- 
cessary, than at any other time. It has been the practice in 
olden times, to rely on the natural evacuation, for the remo- 
val of any disease that might occur about that period. It 
was not then known, that the four to six ounces of discharge. 



* That old men are more benefitted by loss of blood, when disease re- 
quires it, or the condition of their bodies is morbid, than young men. in simi- 
lar circumstances* 



PREJUDICES AGAINST BLOOD-LETTING, ETC. 97 

was not really blood, but an elaborate secretion. And even 
if it were blood, what is the inconsiderable discharge of two 
or three ounces in twenty-four hours, when the nature of the 
case might require the loss of fifty, perhaps an hundred oun- 
ces. We proceed in cases of female patients, throughout the 
whole time requiring special attention, as if the catamenial 
discharge had never been thought of,* as if we had no con- 
cern whether it ever would return. And in ordinary instan- 
ces, it needs no care. It will return with the other functions 
of the system. As its irregularities are consequent on a dis- 
eased state of the system, so its regularity will be restored 
with returning health. 

Similar prejudices have prevailed respecting a state of preg- 
nancy. Happily, however, this is less prevalent now, than 
formerly. The young physician ought to be careful and in- 
sist on the necessity of blood-letting in all cases, when there 
may be proper evidence of an inflammatory diathesis, at 
whatever stage of gestation. For want of this precaution, 
many valuable lives have been lost. The irritable state of 
the viscera, the mechanical pressure, and the constant dispo- 
sition to plethora, all concur to make it often necessary to 
bleed patients in a state of pregnancy, when, that considera- 
tion aside, the practice might safely be omitted. 

An opinion is entertained in some families, that females 
when pregnant, ought to be bled about the third month, and 
that the same ought to be repeated about the seventh. All 
such calculations raised upon periodical necessity, are erro- 
neous. They ought to loose blood whenever it is necessary, 
without regard to months or days; and when necessary, it 
is dangerous to omit it, or even to rely on a substitute evac- 
uation. 

Spontaneous sweating in fever, is supposed to forbid or 
supercede the necessity of blood-letting. In cases of pulmo- 
nics, when suffered to progress a day or two, or more, with- 
out blood-letting, as also, in many instances of violent bilious 
7 



9S PREJUDICES AGAINST BLOOD-LETTING, ETC. 



fever, a profuse sweating often takes place, and appears to 
attend throughout every paroxysm, without affording the 
least relief; indeed in such instances the sweating would 
continue until death. This statement has the support of 
Drs. Rush and Sydenham. " While this constitution (this 
particular condition of the atmosphere) prevailed," says Dr. 
Sydenham, "I was called to Dr. Morris, who then practised 
in London. He had this fever attended with profuse sweats, 
and numerous petechias. By the consent of some other phy- 
sicians, our joint friends, he was blooded and rose from his 
bed, his body being first wiped dry. He found immediate 
relief from cooling diet and medicines ; the dangerous symp- 
toms soon going off, and by continuing this method, he re- 
covered in a few days." Writing of the same fever in an- 
other place, the Doctor says, " For though one might expect 
great advantages in pursuing an indication, taken from what 
generally proved serviceable, (sweating,) yet I have found 
by constant experience, that the patient not only finds no 
relief, but contrariwise is more heated thereby ; so that fre- 
quently a delirium, petechias and other very dangerous symp- 
toms, immediately succeed such sweats." 

Morgagni gives an account of a malignant fever, which 
prevailed in Italy, in which the patients died in profuse 
sweats • their physicians all the while looking for a crisis. 
It is quite probable, that blood-letting might have saved ma- 
ny of them. These instances, and all such, serve to prove 
the correctness of our opinion respecting the state of the ar- 
teries, in all cases of inflammatory fever ; in which these ves- 
sels are injected, while the veins are sJightly filled. And 
whilst this particular subject is before us, we will remark, 
that the petechias just mentioned in the above quotation from 
Dr. Sydenham, proves the same doctrine. W^e cannot con- 
ceive, how they can occur in any case of direct debility. 

In all cases of prostration by loss of blood, or other evacu- 
ations ■ as by catharsis or by cholera,- in the degree of the debili- 



PREJUDICES AGAINST BLOOD-LETTING, ETC. 99 

ty, so is the paleness, or the absence of the blood from the 
skin. When the system is sinking at the close of a F fever 
which has been treated with sufficient evacuations, as the 
debility increases, so also the paleness of the skin. But in 
petechia?, the capillary arteries must not only be filled, but 
they must be filled with a force sufficient to drive the blood 
beyond its ordinary extension, and the spots are produced 
by its effusion under the cuticle. It is true there must be a 
deficiency of absorption in the capillary veins of the skin, 
and the want of adjustment in this particular, may be one of 
the errors which needs to be rectified. But it is equally pro- 
bable that this want of activity in the absorbent system, is 
owing to the morbid expenditure of the sensorial influence 
on the arterial structures. Blood-letting therefore, in such 
cases, serves to interrupt the morbid action, to break the ca- 
tenation of motions on which it is dependent, and while the 
shock is felt, the nerves accompanying the arteries, and 
which are kept in an irritable state by the accompanying 
blood, fall into a state of ordinary quietude, whilst the nerves 
destined to rule over the absorption, resume their power and 
a* balance of the circulation is established. It is true, that 
petechias have generally been considered indicative of a gan- 
greous state of the capillary structures ; and if not speedily 
corrected will be followed soon by dissolution. But Drs. 
Sydenham and De Haen, both bled in these appearances 
with advantage when they were accompanied with an ac- 
tive pulse. Dr. Rush bled a Mr. John Carrol, who was sick 
with petechial small pox. He abstracted fifty ounces of 
blood, when every pock on his arms and legs had assumed a 
purple appearance, and saved his life. It is said that Louis 
XIY of France, when he was thirteen years old, was bled 
five times, to the great honor and emolument of Dr. Forne- 
lius, who urged it against the advice of all the other physi- 
cians of the court. Dr. Cleghorn mentions one case only of 
successful blood-letting in petechial small pox. Dr. Rush. 



100 PREJUDICES AGAINST BLOOD-LETTING, ETC. 



however, thougt it probable that his want of greater success 
was occasioned by his bleeding too sparingly; for he repeat- 
ed it but three or four times. These instances and authori- 
ties show, that in most, if not all instances, fever with pete- 
chias needs blood-letting ; and that the remedy , if well-timed 
and sufficiently repeated, will not disappoint. But such a 
state of things is necessarily urgent, and if permtttedto stand 
any length of time, must present the skin in a state of gan- 
grene. And it is highly probable that a want of proper re- 
gard to this fact, has often led to the conclusion, that pete- 
chias necessarily implied a gangreous state of fever. This 
symptom alone then, ought not to lead to too hasty decision, 
but the whole train of occurrences, and all the existing ap- 
pearances in the case, must be duly considered, without de- 
lay ; and if, upon the whole, blood-letting be indicated, the 
single appearance of petechias need not deter us from using 
the lancet. 



SUPERIORITY OF BLOOD-LETTING. 101 



CHAPTER IX. 

BLOOD-LETTING PREFERABLE TO ALL OTHER DEPLETING 
REMEDIES. 

In a former chapter we gave Dr. Clutterbuek's account of 
the superior merit of blood-letting. We here present our 
own, with the explanatory reasons for our preference of the 
remedy. 

Blood-letting has great advantages over every other me- 
thod of depleting the system. It at once reduces the action 
of the heart and arteries, while the nerves in a good degree 
retain their integrity of power, and if it be carried to any 
point approximating to deliquium, very commonly, so effec- 
tual will be the shock, that the absorbent system comes at 
once into a state of healthy action, and the disease is smoth- 
ered in its onset. Other evacuant remedies are indirect and 
circuitous in their effects, in respect of the action of the 
blood-vessels. 

Yomits, for instance, are sometimes effectual in arresting 
mild fevers in their commencement, and by repetition have 
served to cure such fevers when fairly formed. They dis- 
charge any offensive matter remaining in the stomach, they 
slightly diminish the fullness of the blood-vessels by increas- 
ing perspiration, and they serve to reduce sensorial power 
and lessen the morbid action, by making a counter impres- 
sion on the stomach. But in cases of fever, the stomach is 
often in such a state of torpor, that the operation of an emetic 
is too uncertain. And in cases of pregnancy and in such 
persons as are liable to apoplexy or hoemopthysis, it would 
often be unsafe. In addition to these exceptions, they some- 
times induce cramps and inflammation of the stomach. 



102 



SUPERIORITY OF BLOOD-LETTING. 



The effect of an emetic is not always under the control of 
the physician ; — is often greater or less than is intended. Be- 
sides, even in fever of the mildest form, particularly in chil- 
dren's cases, we have been obliged to recur to the use of the 
lancet, after having used every effort to substitute emetic 
articles. 

Similar objections forbid a reliance on cathartics, in any 
case where blood-letting is clearly indicated. Purges dis- 
charge acrid feces, and bilious secretions from the bowels, 
and when the system is in readiness, are of importance *on 
other accounts, which in their place are as indispensable as 
blood-letting in its proper time and place, which will be ex- 
plained when we come to treat of cathartics. But in com- 
parison of blood-letting, when speedy depletion of the blood- 
vessels is desirable, they are uncertain in then effects. In 
many instances of constipation in fever, and particularly, 
when there is an inflammatory condition of the abdominal 
viscera, ounces of salts and castor oil, and drachms of calo- 
mel and jalap, have been administered without effect. A 
physician of good experience, cannot be induced to rely on 
cathartics in any such case. He will know, that a suffi- 
ciently copious blood-letting, and several repetitions of large 
bleedings are often necessary, before cathartic medicines can 
be made effectual. In cases which require accurate calcula- 
tion, they cannot be trusted, as to the time when depletion 
is desirable, nor as to the quantity: sometimes as to the kind 
of discharge which it would be desirable to accomplish. 
That is, they are not sufficiently under our control. ^More- 
over in many instances of advanced stages of fever, they are 
very unsafe. Scarcely a physician of experience can be 
found, who has not seen instances of death, which have suc- 
ceeded upon copious discharges by stool in debilitated habits, 
and under circumstances too, when there was good reason to 
have expected recovery, had not such evacuations occurred. 
Blood-letting is always preferable to sweating, as a deplet- 



SUPERIORITY OF BLOOD-LETTING, 103 

ing remedy. The popular prejudice in favor of sweating, 
gained its hold on the public mind, when morbific matter 
was supposed to be the proximate cause of fever ; and when 
a remedy once becomes popular, it is wonderful how long it 
will retain its reputation with a great portion of the commu- 
nity. The true philosophy of diaphoresis shall be submitted 
in its proper place ; when it will appear, that the evacuation 
of fluid, in reality constitutes but a secondary part of the 
intention, for which it is judiciously instituted : and of 
course, it is by no means worthy to be compared with blood- 
letting as an evacuant remedy. Besides, when there is a 
great need of diaphoretic treatment, blood-letting or possibly 
a decided repetition of it may be necessary, before diaphoresis 
can be properly established. 

Evacuation by salivation can never be in time to meet the 
demands of an acutely inflammatory case. And in any in- 
stance, to be useful in that respect, it must amount to one or 
two pounds a day. In cases of chronic affections of the 
head, we have seen it eminently serviceable, but in any or- 
dinary case, it is objectionable. It is not always to be pro- 
duced at pleasure, in all cases painful and extremely disagree - 
able, seldom or never popular ; if unsuccessful, always cen- 
sured, except only, in cases reported by the physician to be 
hopeless, if treated in the ordinary way. And if there be 
any want of confidence, no apology will be received as satis- 
factory. 

The evacuation produced by blisters, is sometimes suffi- 
ciently gre-at to be worthy of notice. But in any case of 
inflammatory action of recent date, especially in any instance 
occurring in a person of ordinary health and vigor, it never 
can be a proper substitute for blood-letting. Besides, when 
we come to examine the subject of epispastics, we shall see, 
that their good effects more frequently depend on increasing 
the ability of the skin to maintain its functional action, 
than in any wise on the evacuation which they produce ■•— 



104 SUPERIORITY OF BLOOD-LETTING. 

that the establishment of a blister or issue is instituted, not 
for the sake of evacuation, but for another very distinct and 
important purpose. 

In many cases, abstemious diet or total abstinence may ef- 
fectually resist a threatened attack of fever. But a decisive 
blood-letting would be a more certain and comfortable re- 
medy, and always is more economical, because it saves so 
much more time. None of the foregoing difficulties or ob- 
jections lie against blood-letting. It is speedy in its opera- 
tion and may be accommodated to the demands of the case, 
however hurried or imperious. It is completely within the 
control of the physician and may be employed when and 
where he pleases ; — on a journey, if need be ; and moreover 
he can adapt the quantity, with the greatest precision, to the 
condition of the patient ; — its performance gives the least 
possible trouble, and of course, requires the least possible 
attention from nurses and servants : — a circumstance which 
enables the physician often to aid the poor, who must perish, 
if their cases require much of the nurse's aid. It can be per- 
formed with the greatest safety in many cases, in which the 
agitation, effort and fatigue of either of the other modes of 
depletion, would be more than could be sustained. 

It is by far the most delicate and agreeable mode of evac- 
uating the system ; — produces less prostration than an equiv- 
alent amount of depletion produced by the other methods : 
— and the convalescence which follows, is more certain, 
speedy and perfect, after bleeding, than after the most suc- 
cessful use of the other evacuating medicines. Besides, the 
employment of blood-letting does not preclude the use of any 
of the other agents that may be found necessary; and very 
often, it is absolutely requisite to use them all in quick suc- 
cession. 



THE PULSE AS A GUIDE IN BLOOD-LETTING. 105 



CHAPTER X. 

ON THE PULSE, AS A GUIDE IN THE EMPLOYMENT OF 
BLOOD-LETTING. 

With the foregoing preliminary remarks in view, we pro- 
ceed to consider the circumstances which should regulate 
the use of the lancet. 

In the first place we have regard to the state of the pulse. 

1st. A full and vigorous pulse, without tension ; such as 
occurs in the yellow fever, gout and apoplexy. It was called 
hyDr. Rush, the synochus fortis pulse. To understand this 
specification, it is necessary first to consider the peculiarity 
of pulse which is intended, when it is said to be tense ; which 
as it is felt, makes an impulse on the finger, like a stretched 
cord, drawn tightly lengthwise, from the elbow toward the 
wrist. This synochus fortis pulse is highly important, and 
is often made out with difficulty. The state of pulse which 
most commonly and certainly indicates the necessity of blood- 
letting, is that which we have denominated tense. But this 
synochus fortis pulse, is not tense. It is full, making an im- 
pression on the sense of touch, which reports the arterial tube 
to be displayed to the full extent of its calibre, and which of 
course, implies a general fullness of the system, of which the 
skin in such a case will receive its proportionate participation. 
The arteries and veins are all full. It is also frequent, say 
from one hundred to one hundred and fifty, or even one hun- 
dred and eighty. A kind of motion, of which t it is difficult 
for a young physician to form an adequate conception, until 
a few cases shall have occurred under his own observation, 
and thus have afforded opportunity to know it from experi- 
ence. Neither a fullness nor frequency, constitutes the most 



106 THE PULSE AS A GUIDE IN BLOOD-LETTING. 

characteristic mark which defines this kind of pulse. It is 
full, frequent and vigorous, not much different from the pulse 
of a healthful man, who has lately taken a free potation of 
ardent spirits. The power of the sensorium is vigorous ; the 
blood-vessels and nerves are in possession of nearly a full 
portion of vitality. But the whole system seems to be in a 
state of perturbation or alarm. There is manifest plethora, 
insomuch, that the system would seem to be overwhelmed 
in its own fluids, and is laboring with mighty effort, to keep 
up a degree of motion commensurate with the alarming oc- 
casion. And in fact, the danger consists of a great proba- 
bility of a speedy injection of the meninges, or a suffocation 
of some one or more of the important viscera. Blood-letting, 
therefore, in such a case, serves to make immediate room in 
the blood-vessels ; to give better scope to the circulation, and 
prevent the mischief which would soon follow. A case of 
this sort needs special care. For if blood-letting be in time, 
the cause of the stormy excitement still acting on the system, 
it must follow, that the state of the pulse, which was at the 
first full, frequent and vigorous, without tension will change 
its character on depletion, and when the reaction shall have 
occurred, there will be a degree of tension, presenting the 
case under a new aspect. So soon as this tension is suffi- 
ciently expressed, it will be the signal for further depletion ; 
and as often as the tension recurs, especially if attended with 
pain, or soreness in any of the viscera, so often should the 
blood-letting be repeated. This last remark, however, is 
predicated on the supposition, that the first blood-letting shall 
have been effectual in changing the state of the excitement ; 
and that the sensorial centres, nerves and blood-vessels, all 
retain a goodly portion of vitality, so that when the thraldom 
of plethora is removed, all the powers and organs of the sys- 
tem, at once come into free and vigorous action. And this is 
invariably the fact, whenever a second, a third or fourth 
blood-letting is found to be necessary. We have seen in- 



THE PULSE AS A GUIDE IN BLOOD-LETTING. 107 

stances, however, which probably in the commencement 
were marked by this kind of synochus fortis pulse, but in the 
course of twelve hours, sometimes in less ; in twenty-four, or 
thirty hours, have become so languid, that a single blood- 
letting would have produced a fatal collapse. We have seen 
others in which blood-letting appeared to be the only hopeful 
remedy, but it was employed too late. And others again, 
have come under our observation, as to all appearances, 
equally unpromising, which were relieved by a well-con- 
ducted use of the lancet. In those neglected cases, which 
progressed most satisfactorily, the blood was drawn slowly, 
from a small orifice, and as the system was gradually light- 
ened, the blood flowed with a gradually increasing impetus. 
The distinction of appearances and circumstances, which 
might enable the physician to decide with certainty in such 
cases, when the system has been in thraldom too long, so as 
to render the blood-letting unsuccessful, and when we might 
venture with confidence to promise relief, have not yet been 
fully made out. And in a large majority pf the cases, there 
must be uncertainty, as to the issue, till science shall have had 
more time and opportunity, to make the subject plain and 
easy. 

We repeat an epitome of this state of the pulse. It is full, 
frequent and vigorous, obviously expressive of great perturba- 
tion ; but not tense. In accompaniment with hot skin, wild- 
ness of expression in the eye, heaviness of respiration and 
other evidences of oppression. Such is the state of things 
in the onset of malignant fever. The system is in the condi- 
tion which is plethora; the remote cause is greatly stimulant, 
urging the heart to violent effort. The injection of the arte- 
rial system, is exceedingly great ; the labor of the heart very 
oppressive, the sensorial influence being very rapidly ex- 
pended. The sensorium is soon prostrated partly by the 
exhausting demands of such excessive excitement, possibly 
more by the pressure made on the sensorial structures by the. 



10S THE PULSE AS A GUIDE IN BLOOD-LETTING. 

carotid arteries. The capillaries are hastily overbalanced by 
the flood of the circulation, or left decrepid by the tiring 
heart. The great viscera meanwhile in corresponding state. 
If sufficiently bled in time, the victim lives — if the intended 
relief comes too late, he dies. One fact more, however, ought 
to be noticed. Although we might sometimes use the lancet 
without success in such a case, other remedies, perhaps I 
may say all other remedies yet tried, have been found to be 
as often used without success, as blood-letting : so that on 
the whole, it may be safely inferred, that appearances are so 
nearly alike, when the system is approximating to the neplus 
ultra, and any short time afterwards, it is no just cause of 
disparagement, not to be able to know with certainty, the 
precise point or moment of time, at which, the case becomes 
incurable. To conclude this article, the best inference to be 
taken from the whole, is, that in all such cases, the sooner the 
physician is sent for the better. 

Another state of the pulse indicative of blood-letting is "a 
full, frequent and -tense pulse, such as occurs in the pulmo- 
nary, rheumatic, gouty, phrenitic and maniacal states of fe- 
ver." This distinction of the pulse is more readily made 
out than any other, and in the northern and middle states, 
most frequently claims attention. Contemplate the artery 
as being nearly or quite well distended at every systole, with 
a calibre of full size, and well charged with blood : at every 
stroke making an impression, as if it contracted lengthwise, 
from the elbow to the wrist, and performing its impulse, as if 
with very considerable force, and you have the view of it, 
as it presents itself to observation on the first paroxysm of 
fever, of this description ; in which state it will remain often 
several hours. But all the time it is permitted to remain in 
this state, there is continually increasing danger of great and 
fatal congestion. The danger of the full, frequent and vig- 
orous pulse, not tense, is, that of morbid distension and ge- 
neral decrepitude of the blood-vessels of the abdominal vis- 



THE 'PULSE AS A GUIDE IN BLOOD-LETTING. 109 

cera, such as constitutes congestive fever of sickly districts. 
On letting blood on this state of pulse, as soon as it is well 
understood, the practice may be regulated with the utmost 
degree of exactness. The quantity of blood to be drawn, 
may always be adjusted to the demands of the case. And 
as accurately, if permitted to flow into a pit y as if measured 
in a graduated cup. The quantity necessary to be taken in 
any such case is, just so much as may serve to change the 
state of the pulse ; that is completely to retire its tension. 
And however effectually it may be done, so long as any con- 
gestion or inflammatory disposition of the blood-vessels re- 
mains, there will be a recurrence of the tension ; sometimes 
at longer, sometimes at shorter intervals. In pleurisy, rheu- 
matism, and mania, sometimes in six hours, sometimes in 
twelve, and sometimes in twenty-four hours. If the blood- 
letting be effectually performed, so as to reduce the tension 
well, the interval of time, between the instances of recurrence 
of the tension, will be longer, till the fever will become pe- 
riodically diurnal, and at length it will disappear. If the 
tense pulse be neglected too long, it will not fail to change 
its condition. The injection of the arterial system may be- 
come so general, and the long struggle of the heart may so 
wear down sensorial energy, that the tension may with diffi- 
culty be made out. We have found the pulse in neglected 
pulmonitis, so very similar to a typhoid pulse, that we should 
not have been able to detect the indications of blood-letting, 
had we not been informed of the history of the case. But 
when such a state of things occurs in pneumonic affections, 
it is an interesting fact, that blood-letting changes the state 
of the pulse ; and after it has been repeated once, twice or 
thrice, the artery is expanded and filled, so that a pulse of 
apparently very doubtful character, a pulse which we shall 
denominate a chord-like pulse, becomes full, free and tense * 
and not uncommonly, after the loss of blood enough to set 
the system free, the case becomes a plain and easy one, and 



112 THE PULSE AS A GUIDE IN BLOOD-LETTING. 

ficient skill in the tact of pulse feeling and adjusting deple- 
tion to the existing state of things, would enable the physi- 
cian to succeed in many cases, in which, with other views, 
he would fail, even in using the same remedies. Before we 
dismiss this point, we will say, that any man who hesitates 
to adopt this practice, in regard of those four diseases, must 
have erred in his manner of making observation, or has not 
seen a sufficiency of the practice, to be a judge of its supe- 
rior worth. The wonderful extent to which blood-letting 
may be carried in them, safely ; the reiterated necessity of 
repeating the operation ; and the certainty with which many 
cases are cured, and all more or less relieved j all concur to 
sustain the opinion, that these diseases, having suitable res- 
pect to each in view of its particular modification, are all in- 
trinsically resident in the blood-vessels. When a case of this 
sort is permitted to progress, that state of things which we 
denominate congestion, almost invariably occurs. When 
this shall have happened, it is important that it should be 
understood. In the onset of pulmonitis, we let blood freely 
with intention to reduce the impetus of the heart, and 
to prevent any further extension of the lesion. For the same 
reason the blood-letting is repeated, as often as the reaction 
is sufficiently potent to endanger the injured vessels ; — still 
looking for the co-operation of the absorbents, for the remo- 
val of any misplaced fluids which may have been extravasa- 
ted, or accumulated in the distended capillaries. And whilst 
the case is recent, the diminution of arterial pressure, aided 
by the elasticity of the vessels, and the improving state of 
the organs intended to give transition to the fluids over from 
the arteries to the veins, will be found speedily adequate to 
the recovery of health. Indeed in some cases, when it was 
scarcely probable, we have seen the most speedy and perfect 
relief. 

But when the system has not been aided by timely blood- 
letting, and extensive congestions have been permitted to 



THE PULSE AS A GUIDE IN BLOOD-LETTING. 113 

take place, all the precautions given in a former chapter will 
be necessary. The blood-lettings will be more cautiously 
performed and in less quantities ; and more reliance will be 
placed on the recuperative powers of the absorbents. The de- 
cision which would be proper in the former case, would be 
dangerous in a case of this sort. In the commencement of a 
pulmonic's, it is particularly desirable to avoid every sort of 
irritation. We endeavor therefore at the commencement of 
every paroxysm, to reduce the action and retire the pain. In 
neglected cases, it is important that the congested tissues 
should feel the inconvenience of each exacerbation to a suf- 
ficient extent, to maintain their vitality, and excite the ab- 
sorbents to the necessary action. We deplete therefore, with 
the intention to keep the arterial action sufficiently subdued, 
but duly take care to let the fever rise sufficiently to irritate 
the congested vessels and excite the absorbents. By this 
method we retire the misplaced or extravasated fluids, and 
the injured vessels gradually return to their natural state and 
recover a due degree of tone. In a case where we can meet 
the first exacerbation,, we would let blood nearly to deli- 
quium, and repeat the blood-letting on the rise of each sub- 
sequent paroxysm ; — that is, forestall its rise. In a neglected 
case, we would permit the return of the paroxysm to be well 
displayed, before we would repeat the bleeding ; that is, we 
would let the fever fairly show itself before we would again 
deplete. 

For many years, we have employed blood-letting as a 
most valuable means for the removal of chronic affections of 
the viscera ; whether thoracic or abdominal. Sub-acute in- 
flammation as well as that which is most acute, needs to be 
treated by blood-letting, either by means of the lancet or by 
cupping or leeching. When the action of the heart and ar- 
teries is kept sufficiently subjugated, the absorbents gain the 
ascendency, and long standing congestions are removed. 



8 



114 ADDITIONAL REMARKS ON THE PULSE. 



CHAPTER XL 

ADDITIONAL REMARKS ON THE PULSE, &c. 

r 

Another distinction of pulse, indicating the necessity of 
blood-letting, is " a full, frequent and jerking pulse, without 
tension, such as often occurs in the vertiginous, paralytic, 
and hydropic states of fever." This description of the pulse, 
like the first which we have noticed, is described with diffi- 
culty, so as to make it intelligible to an inexperienced physi- 
cian. The association of diseases, is given in reference, for 
the purpose of explanation. A peculiar fullness of the vessels 
of the head, produces the embarrassment of thq circulation, 
which that state of things would imply; nearly the same 
might be looked for in a case of dropsy, in which the whole 
system is oppressed. * In affections of this sort, blood-letting 
can hardly fail to afford some relief, and the subsequent rep- 
etitions of the practice, must depend on the effect, as to the 
state of the pulse at the first and the subsequent bleedings. 
If the practice be proper, the frequency of the pulse will not 
be materially increased by it ; nor will it be followed by any 
signs of increasing prostration. If it promise much benefit, 
the frequency will be diminished and the peculiar jerking 
will cease, inasmuch as the pressure which produces it, re- 
tires as improvement is made, from time to time, by the 
blood-letting. The peculiar quickness and struggle, which 
is intended by calling it a jerking pulse, is particularly re- 
markable, and yet it is so, only in a comparative sense, and 
will be pretty readily discovered by one in habits of feeling 
the pulse, so as to be able to apprehend the comparative dif- 
ference. The first description, is supposed to exist in apo- 
plexy, which we have described, full, frequent and vigo- 



ADDITIONAL REMARKS ON THE PULSE. 115 

rous j the vertiginous, paralytic and hydropic pulse, is de- 
scribed as being full, frequent and jerking. The former is 
an account of it, in those alarming and overwhelming affec- 
tions, which soon find a termination, like apoplexy; the lat- 
ter as it is exhibited in those instances which are similar,- but- 
always give more time ; so that the degree of vigor which 
marks the impetus of the systole, in the former case, is di- 
minished, and the vigorous motion is exchanged for the jerk- 
ing motion, which describes the latter. 
* Another distinction of the pulse which requires blood-let- 
ting, is '•' a small, frequent, but tense pulse, such as occurs in 
the chronic pulmonary and rheumatic states of fever, and in 
neglected enteritis." We have given a pretty full account of 
the tense pulse, in our second definition. In this place we 
will add, that a tense pulse may be considered as the most 
infallible, of all the known symptoms, which indicate the 
propriety of blood-letting ; yet the smaller and more frequent 
the tense pulse is, the greater the circumspection necessary 
as to time and the quantity of blood to be drawn ; — especially, 
upon the first bleeding. It is important that no more should 
be taken at the first, than is barely sufficient to change the 
expression of the pulse ; inasmuch as there may be very ex- 
tensive congestions, and if the circulation be too much re- 
duced at once, the vitality of some portion of the congested 
vessels, might be endangered ; in which case, the frequency 
would be increased by the bleeding j and symptoms indica- 
tive of dissolution would soon follow. This precaution is 
more particularly important in cases of pulmonary affections. 
If the blood-letting promise to be useful, in the course of a 
few hours the system will react with a return of the tension ; 
— and as often, as the reaction is considerable, with distinct 
tension,,, so often* the blood-letting is to be repeated. In 
such pulmonary affections, there is also more or less pain or 
soreness, which affords additional aid in determining the* pro- 
priety and necessity of depletion. The recurrence of the 



116 AEDITIONAL REMARKS ON THE PULSE. 

pain, will pretty uniformly be periodical, growing worse, 
regularly, every day, about eleven or twelve o'clock ; and 
about the same hours at night. It should therefore be the 
business of the physician, to be present about those hours, in 
order to time the remedy in accordance with the periodical 
movements of the disease. It will be found moreover, that 
whenever the pulse is thus frequent and tense in pulmonary 
affections, the skin will be imperfectly supplied with circu- 
lation ; and that we might carry the blood-letting further 
than necessary, if we neglect the use of measures calculated 
to maintain the skin in a proper condition. Early and exten- 
sive blistering, repeated so as to make the irritation continu- 
ous, is necessary in all cases of this sort. 

As to rheumatism, when it takes on the condition of pulse 
here described, and when it will be proper to consider it as 
subacutely inflammatory, very nearly the same kind of prac- 
tice will be found necessary in every instance. We have 
said when it should be considered to be subacutely inflam- 
matory. Rheumatism has been divided by nosolegists into 
two distinctions, inflammatory and chronic. In the first, 
directions are given to let blood and administer antiphlogis- 
tic medicines. In the other, an opposite plan of practice, of 
course, is deemed necessary. No modern physician of good 
information and experience, will subscribe to such distinc- 
tions or practice. They all know, that rheumatism, after it 
has continued for months, may be inflammatory, attended 
with "a small, frequent and tense pulse," and require topical 
bleedings, sometimes frequent repetitions of them :. and that 
such cases will not yield with readiness, if at all, without 
this kind of practice. 

Another and highly important distinction of pulse, we shall 
designate as cord-like. We give it this appellation as being 
most expressive of the impression made by it, on the sense 
of touch. It feels like a loose cord, which can with great 
ease be made to slide from side to side of the space com- 



ADDITIONAL REMARKS ON THE PULSE. 117 

monly occupied by the pulse, and is more or less incurvated, 
as if longer than the arm. In this last particular, it is the 
reverse of a tense pulse. When full, frequent and tense, it 
always implies danger of a speedy congestion. The action 
of the heart and arteries is vigorous, and while struggling al- 
most to weariness, the tension irritates and excites them to 
frequency of effort ; and if this state of things be suffered to 
continue, pernicious congestions or an established irritation, 
must soon follow. When either of these circumstances shall 
have occurred, the full, frequent and tense pulse, will become 
small, frequent and tense. If however the amount of injury 
be such as that it can be sustained a sufficient length of time, 
the violence of the heart's action will abate, and the tension 
of the pulse will gradually be exchanged for the cord-like 
state ; leading an inexperienced observer to suppose the 
change to be, the commencement of convalescence. A large 
proportion of chronic diseases, almost all of the affections of 
the viscera, which are subacutely inflammatory, present the 
pulse in the cord-like state. It will be found to obtain in a 
large majority of fevers and other diseases, which may have 
required more depletion than the attending physician would 
allow, and in which nature has been left to make her own 
adjustments, whilst the tissues of vessels were remaining in 
a state^ of congestion. Thus an inflamed eye, left to recover 
without the aid of sufficient depletion, may at last be relieved 
of pain and of the common appearances of inflammation, but 
the coats of the organ are thickened, the cornea is more or 
less opaque, and a very slight cause readily excites renewed 
inflammation. In a similar manner, if congestion or irritation 
be not entirely removed by means of sufficient depletion, the 
symptoms of an inflammation readily recur. And if the cord- 
like pulse be felt, in any case thought to be convalescent, let 
the attending physician be admonished of his mistake. 
There will certainly be consecutive mischief ;— either a re- 
lapse or permanent invalidity will follow. A sabaeuiely in* 



US ADDITIONAL REMARKS ON THE PULSE. 

flammatory condition of the sensorial structures, under such 
circumstances, will be followed by permanent head-ache : — 
a similar condition of the thoracic viscera, will be followed 
by a condition of things tending to phthysis : — or of the liver, 
by a condition tending to chronic hepatitis ; — or of the stom- 
ach and lower intestines, by the symptoms constituting the 
various aspects of dyspepsia, &c. &c. All these evils, have 
been consequent on a timid or too sparing use of the lancet. 
Most of the instances of hypertrophy are produced by the 
same cause. The blood too long detained in any portion of 
the capillary structures, serves to institute a morbid applica- 
tion of the function of nutrition. The morbid process when 
once established, progresses indefinitely, till arrested by al- 
terative means ; which ought to be employed in association, 
with suitable attention to the condition of the external capil- 
laries, till health shall be recovered. In pursuing this plan 
of treatment, it commonly happens, that the material taken 
up by the absorbents, through the influence of the alterative 
agents, renders the fluids sufficiently stimulant, or the blood- 
vessels, by the practice, become sufficiently irritable, or the 
two circumstances combined, serve, to institute a new action ; 
blood-letting then becomes admissible and the character of 
the pulse is changed ; the cord-like condition begins to retire, 
a tendency to the tense state returns, and by a judicious con- 
tinuance of alterative means and an occasional blood-letting, 
the chronic affection is eventually corrected, and the pulse 
assumes its natural state. There are instances forming ex- 
ceptions to these remarks, respecting the cord-like pulse. 
Some are found, who having been invalids for years, enjoy 
their usual share of health, whilst the pulse is habitually and 
uniformly cord-like. So also men and women, who have 
been accustomed to hard labor for many years, and particu- 
larly such as have regularly used alcoholic drinks, or have 
for a long time smoked or chewed tobacco, in like manner 
have the same kind of pulse, and seem to have a pretty good 



ADDITIONAL REMARKS ON THE PULSE. 119 

portion of health. In the last eventually, as years increase 
in number, many furnish instances of induration of' the arte- 
rial structures, possibly of ossification ;— when the pulse felt 
at the wrist presents a knotty condition as of a line of beads 
strung at unequal distances. Perhaps most of these cases, 
may have been affected with fever^an irritated state of the 
blood-vessels may have been permitted to run through a long 
continued course, and at length an imperfect kind of recov- 
ery, made habitual by continuance is established, leaving the 
arterial tubes in this peculiar condition. The subject merits 
further attention. 

Another description of pulse requiring blood-letting is a 
11 tense and quick pulse, without much preternatural frequen- 
cy." " This state of pulse is common in the yellow fever.*' 
We have met with a few cases only, corresponding to this 
definition. The pulsation is performed at intervals of time 
equally divided, and at the rate of seventy or eighty strokes 
in a minute. But the manner of it has a peculiarity, which 
is, perhaps, as fully described by the definition as it can well 
be. It is tense, with a peculiar suddenness of action, of 
which a very inadequate conception can be formed by any 
one who never felt it. 

Another description of pulse requiring depletion is a slow 
and tense pulse, such as occurs in the apoplectic, hydroce- 
phalic and malignant states of fever ; in which, its strokes 
are from sixty to ninety in a minute." A moderate degree 
of acquaintance with the nature and indication of an ordi- 
nary tense pulse, would prepare any physician of tolerable 
information, to meet a case of this sort with his lancet, and 
repeat the use of it, with becoming decision. The seats of 
the disease, the unequivocal signs of fullness, together with 
the force which tension always indicates, would be consid-? 
ered sufficient proof of the necessity of this potent remedy. 

We occasionally meet an uncommonly U frequent pulse 
without much tension, beating from one hundred and twenty 



120 ADDITIONAL REMARKS ON THE PULSE. 

to one hundred and seventy or eighty strokes in a minute.'' 
: - This state of the pulse likewise occurs in the malignant 
forms of fever. It is not peculiar to malignant fevers, how- 
ever. It always implies great plethora, and a perturbation of 
excitement, which calls for a speedy evacuation ; and if relief 
be afforded in this way before a fatal disorganization takes 
place, the frequency is often lessened by the first cautious 
bleeding, and commonly, upon the retirement of this great 
frequency, the character of the pulse will change, so as to 
place it entirely under another head of description. The 
bleedings for a day or two should be moderate in quantity 
and timed with great circumspection. These last remarks 
in reference to frequency of the pulse as an indication requi- 
ring blood-letting, are intended to apply to incipient cases 
only. 

When the system has been broken down by disease ; when 
great prostration is consequent on a fever or other affection 
about to terminate in death, we scarcely need to add. that no 
man in his senses would think of letting blood. 

In some instances the pulse is '-'soft, without much fre- 
quency or fullness.' 5 This state will be met in affections of 
the brain, in bronchitis, and sometimes, in a sub-acute inflam- 
mation of the abdominal viscera. In cases of this kind, the 
pulse often becomes tense after bleeding, and then may be 
treated as any other instance of similar expression. This 
state of things, as well as the foregoing, requires very great 
circumspection. The first bleeding in most instances of 
either of the two, should be performed with a sparing hand, 
and the physician ought not to leave the bed-side of the pa- 
tient, until he is sufficiently informed, respecting the effect of 
the operation. For, in all such cases, if the reaction be slow 
and imperfect, the practice should be of the mixed kind : — 
suitable, mild excitants, as hot drinks, external application of 
heat, sinapisms and epispastics, should be associated to insure 
the reaction ; and then the depletion should go on according 



ALDITIONAL REMARKS ON THE PULSE. 121 

to the demands of the case. Let the patient sit erect whilst 
the blood is flowing. 

Again, there is an " intermittent pulse." It ought to be 
remembered, however, before we lay too much stress on this 
circumstance, that with some particular constitutions, this ap- 
pears to be habitual, and with most old people it is so. In 
many cases of old persons, whose pulses habitually intermit, 
so soon as there is feverish action to a degree requiring blood- 
letting, the intermission disappears, but returns again after 
depletion, and its reappearance is the best indication of 
recovery. 

Much remains to be learned on the subject of the pulse, 
and particularly in view of diseases of the head. Mr. Hun- 
ter, in his treatise on inflammation, chapter III, section 9, 
observes, that " in inflammation of the brain, the pulse varies 
more than in inflammation of any other part ; and perhaps 
we are led to judge of inflammation there, more from other 
symptoms, than the pulse." The slow, uncommonly fre- 
quent, intermitting and imperceptible states of the pulse, 
which require blood-letting, may be distinguished from sim- 
ilar states, when they accompany an exhausted state of the 
system, and of course forbid blood-letting by the following 
marks : 

They occur in the beginning of a fever and under circum- 
stances which would have led to the expectation of a very 
different state of things. 

They occur in the paroxysms of fevers which have remis- 
sions and exacerbations ; — of course, if we should hesitate at 
the first, the next paroxysm will enable us to decide with 
fearless confidence. 

They sometimesNDccur after blood-letting, in consequence 
of the additional power with which the arterial system pro- 
pels the circulation for a time, after having been released 
from thraldom by blood-letting. 

They sometimes occur and continue throughout the whole 



122 ADDITIONAL REMARKS ON THE PULSE. 

course of an inflammation of the stomach and bowels. A 
small, frequent and tense pulse, seems to be pretty commonly 
one of the characteristics of inflammation of those organs. 

And finally they occur in cases of relapse,' after the crisis 
of fever. If the disease in the first onset needed blood-let- 
ting, and more particularly, if it called for a repetition of the 
practice, the same will commonly be necessary in case of a 
relapse. 

Sometimes it happens, that fever appears to terminate 
kindly, when the depletion may have been too sparing, but 
so soon as the patient is permitted to take nourishment, 
symptoms take place like a relapse, and in a very imperious 
manner again call for blood-letting. Such circumstances 
often occur to females, about the second or third week, some- 
times at a later period, after parturition. 



DIRECTIONS FOR FEELING THE FULSE". 123 



CHAPTER XII. 

DIRECTIONS FOR FEELING THE PULSE. 

It will be observed by the reader, that the great variety of 
considerations which have been submitted in respect of the 
pulse, would necessarily imply, that an occasion would be ta- 
ken to give some instruction as to the manner of feel- 
ing it. 

Let the arm be placed in such a position, as shall serve to 
relax the muscles and prevent any pressure upon the artery 
in the axilla. This is most effectually done, by directing the 
patient to lie on his back, or nearly so, during the time of the 
examination. Take the necessary time, and, feel both arms, 
especially in all difficult cases. Lay hold of the patient's 
wrist, in such a manner as to be able to apply ail the fingers 
of one hand to the pulse. This we have often found of great 
use in very difficult cases. In order to obtain the advantage 
to which we refer, it will be best to feel the left hand of the 
patient with our right, and the right with our left. But we 
should remember the possibility of an error loci of the artery. 
It is often ramified near the wrist, one branch only retaining 
the ordinary location. 

We ought not to decide upon blood-letting in difficult ca- 
ses, till we have felt the pulse for some time. We should 
feel it at intervals of five or more minutes, whenever we have 
cause to suspect that its condition may have been varied by 
any contingency not properly connected with the disease ; 
such as emotions of the mind, which may be produced by 
our arrival, or by the conversation or deportment of friends, 
or by-standers. If any recent exercise have been taken, or if 



124 DIRECTIONS FOR PEELING THE PULSE. 

the patient have lately been eating or drinking, all these cir- 
cumstances ought to be taken duly into consideration. If 
the pulse cannot be felt at the wrist, we may try the carotid, 
temporal, or femoral arteries. In difficult cases, we request 
silence in the sick room, and close our eyes whilst we feel the 
pulse. In this way we concentrate the power of all our sen- 
ses in our fingers, and our sense of feeling will be more acute. 
These general rules were observed by Dr. Rush, and we have 
regarded them with little or no variation for forty years. In 
exercising our judgment according to the various states which 
have been enumerated, and with a reference to the rules 
which have been laid down, it will be proper to notice the 
difference in the frequency and force of the pulse, morning 
and evening ; between sleeping and waking; between a full 
stomach and inanition. 

But after all that has been advanced, perhaps the greatest 
difficulty is, to determine on the necessity of blood-letting, 
in cases where the pulse reports no sign of disease. One 
general observation may be of use here. If the disease be 
of recent date ; the part affected be one of the organs impor- 
tant to life, and one which cannot sustain violent morbid ac- 
tion, without danger of lesion ; if the pain be great and respi- 
ration difficult ; if there be redness of the face ; watery, live- 
ly, or suffused eyes; in such cases the pulse may be disre- 
garded in determining to use the lancet. 

Dr. Sydenham added to these a flushing of the cheeks, the 
escapement of a drop of blood from the nose, and an obsti- 
nate continuance of a hot skin. But all these marks of Dr. 
Sydenham are uncertain, and must not be taken for guides 
without the support of the foregoing rules and indications. 
It is always important to have regard to the generally pre- 
vailing temperament of the season, as it may be discovera- 
ble in our every day practice. There is some difficulty in 
making ourself understood in this particular. Dr. Rush 
taught, that regard should be had to the character of the 



DIRECTIONS POP. PEELING THE PULSE. 125 

reigning epidemic, in deciding upon blood-letting. In at- 
tending to this important admonition, we have acquired the 
habit of applying the rule to current appearances, as they 
occur in the round of the season, and are now satisfied, that 
it is a most useful kind of observation. Dr. Sydenham was 
convinced that the " atmosphere took on various constitu- 
tions;" that the variations were produced by extensive evo- 
lutions, or exhalations of some kind of gas, which proceeded 
from the bowels of the earth ; and that these exhalations 
produce and govern epidemic diseases. 

The seasons do vary. The condition of the atmosphere 
no doubt undergoes such changes as may make important 
difference in the condition of animal and vegetable life. The 
physical circumstances which tend to the production of cold 
or warm temperature, of seasons favorable or unfavorable to 
luxuriant vegetation j of modifications in respect of electri- 
city and caloric, and the course of wet and dry weather ; 
these circumstances affect the ethereal influences, and the 
proximate or constituent principles which enter in the ali- 
ments of men, in such a way, that the same persons, the 
members of the same family, the inhabitants of the same city 
or district of country, will need blood-letting some seasons 
under appearances which, in other seasons, would not call for 
loss of blood. But all these agencies or influences are out of 
sight, and the only notice we can take of them is, that such 
variations of general temperament do occur. For ourself, 
we make daily observations in reference to the probable 
changes which are thus brought about. In letting blood, in 
a number of instances, apparently under similar circumstan- 
ces, regarding the same rules and principles of judging-, we 
learn very often, that blood-letting is less important in one 
month than in another ; in one season than in another ; all 
appearances being the same. But our judgment becomes 
modified by continued comparative observation, so that we 
are seldom taken by surprise by changes in the general type 



126 DIRECTIONS FOR FEELING THE PULSE. 

of fever. If then, by general observation, we may have as- 
certained that a disposition to inflammatory action obtains 
generally, bleeding may be used with more safety and ad- 
vantage in cases where the indications of it from the pulse, 
are more or less doubtful. The pestilential fever which fol- 
lowed the plague in London, in 1665, Dr. Sydenham says, 
yielded only to blood-letting. Dr. Rush was of opinion, that 
it is equally necessary in all the febrile diseases which suc- 
ceed malignant fevers, for many months. 

We have moreover to regard the seasons of the year, and 
the state of the weather. It is more frequently and copious- 
ly indicated in the winter and spring, than in summer and 
autumn ; and in dry than in wet weather. This last is very 
worthy of notice, and it accords with our views of reaction, 
which will always be found to be materially affected by wet, or 
even cloudy weather. This was noticed by Dr. Huxham, who 
remarks, that it is a fact observable in diseases of the chest. 

The constitution and habits of the patient ought also to be 
regarded. A person known to be plethoric, and in habits of 
blood-letting, will need the remedy in instances and circum- 
stances in which others might safely do without it. And 
persons of a lymphatic temperament, and especially such as 
are corpulent, must be bled more cautiously and sparingly, 
than those of sanguineous temperament and habits of body. 
Of persons of similar temperament, those who are of larger 
structure can lose more blood than those of less. And in 
persons between fifty and sixty years of age, more blood 
may be drawn at once, than from similar persons in middle 
life, in similar diseases. In persons over seventy, we must 
use very great discretion, as the pulse is generally full, and 
the blood, when drawn from such persons in health, will imi- 
tate the appearances which we would expect in inflammato- 
ry action. 

Regard must be had to the country or place in which a 
person affected with fevers resides, or where he may have re- 



DIRECTIONS FOR FEELING THE PULSE. 127 

cently resided. Fevers in America are more inflammatory 
in persons of similar rank, than in Great Britain. And in 
those from the interior, than in those who reside near the sea- 
board, in the western states. Ship-captains from this coun- 
try, have had the misfortune, when sick of pulmonitis in 
London, to be so treated, that their diseases have terminated 
in abscesses of the lungs, though attended by the ablest phy- 
sicians of that city. One or two bleedings, have been trusted, 
when six or eight have been necessary. And it is a fact, 
that recent emigrants from England or Ireland, commonly 
require decisive blood-letting, when they sicken in Balti- 
more, and the southern States, &c* 

We must also have regard to the structure and relative sit- 
uation of the parts or organs, which are the seats of diseased 
action. The brain, because of its paramount importance to 
all the functions of life, the rectum when highly inflamed 
with hemorhoidal tumors, or other inflammatory affection, 
the bladder, the trachea, and the intestines when affected 
with inflammation, either from strangulation or other causes j 
hernia humoralis ; all require more copious bleedings than 
diseases of the same degree of intensity in the lungs, or oth- 
er parts of the body, because they are so much out of the in- 
fluence of the general circulation. In these remote parts, it 
would seem, that injections bordering on conjestion, or that 
a conjestion when really established, will remain and con- 
tinue their tendency to destruction, until the depletion shall 
have been so complete as to take off almost the whole pres- 
sure of arterial action. Sudden relief cannot be produced ; 
and therefore, we must rely on the absorption which will 
eventually be excited by the irritation of the parts ; the arte- 
rial action first having been properly subdued. 

* We mean, having arrived in health, and remained in healthful condition 
long enough to have come under the influence of our climate. 



128 WHEN THE LANCET SHOULD BE CAUTIOUSLY USED. 



CHAPTER XIII. 

CONSIDERATIONS FORBIDDING THE USE OF THE LANCET, 

OR REQUIRING A CAUTIOUS AND SPARING 

EMPLOYMENT OF THAT REMEDY. 

Pains having been taken to show how extensive the ne- 
cessity and benefits of blood-letting, and to designate the 
points and distinctions, which are to regulate its use ; it will 
be equally necessary, that we should mention some of the 
circumstances and states of fever, in which it is forbidden, or 
in which it should be cautiously or sparingly used. 

There are instances in which the brain or viscera are in such 
a state of congestion, that the whole system is prostrated, be- 
low the point of reaction. Something like this probably oc- 
curs in those eases, when the pulse becomes imperceptible in 
the early stages of fever ; and when there is a stagnation of 
the circulating fluids. The skin and superficial veins being 
nearly or altogether emptied of their blood, a cold and clam- 
my state of the surface, with the appearance of a livid hue 
about the mouth and eyes, make it obvious that the abstrac- 
tion of blood not only would be improper, but if it were at- 
tempted, could not be accomplished. This is the state of 
things, in what is called congestive fever, in the south and 
west. In such instances suitable measures must first be 
taken to rouse the capillaries of the skin ; extensive sina- 
pisms, sometimes covering the thorax,, abdomen and extrem- 
ities ; — flannels wetted with whisky or vinegar aided by heat 
and capsicum, &c. &c. ; — or spirits of turpentine or Gran-. 
ville r s lotion ; — hot drinks slightly stimulant ; — injections of 
turpentine or capsicum; — or spirit and water may be used as 
there may be occasion. In almost any such instance, s"o 
soon as we shaLl have succeeded in exciting the capillary 



WHEN THE LANCET SHOULD BE CAUTIOUSLY USED. 129 

action, blood may be drawn j but always, in such cases, in 
small quantities at a time ; sometimes we should rely on cups 
and leeches only; making the application according to the 
seat of the* disease, if it can be satisfactorily located. The 
practice conducted in this way, will favor a little the circu- 
lation of the blood in the viscera, and the blood will become 
more equally diffused. With the return of the blood, the 
nerves will be revived, and blood-letting may be performed 
in the ordinary way and repeated as there may be occasion ; 
and all subsequent appearances will be such as usually occur, 
and such as they would have been, if the suffocation which 
had given the alarm, never had taken place. 

Blood-letting is seldom proper in a case of malignant 
fever, after the third day: the congestion, by that time, will 
be found to have nearly extinguished the vitality of the dis- 
tended vessels, or to have brought them so nearly to such a 
condition, that they cannot sustain blood-letting. In such 
cases, the blood-vessels will not afford proper indications for 
the use of the lancet, and if there be any possibility of relief, 
it is to be had in the use of external heat, sinapisms, blisters, 
gentle cathartics, and management. 

Blood-letting is to be performed with great circumspection 
in intermittent fevers. It ought always to be carefully 
timed. When the patient shall have gone through the 
chilly, hot, and sweating stages, very often, a degree of de- 
bility prevails, so great, that a moderate blood-letting might 
endanger life. Further instructions will be given in another 
place. 

Bleeding is forbidden in most instances, when the pulse is 
weak and frequent, such as we often meet in typhus gravior ; 
in the plague • malignant sore throat, &c. In such cases, 
we rely on sinapisms, gentle emetics and purges, and after- 
wards on cordials. In the subsequent use of cordials an op- 
portunity is afforded to ascertain, whether the viscera are all 
in readiness for action. If not, the cordial treatment will 
9 



130 WHEN THE LANCET SHOULD BE CAUTIOUSLY USED. 

produce symptoms, which will report the necessity of blood- 
letting, which when commenced, will be followed by appear- 
ances, such as attend on depletion properly employed in any 
other circumstances. 

We must be very circumspect in prescribing blood-letting 
in any disease of habitual drunkards. Such are often affected 
with apparently violent attacks : but they commonly recover 
with surprising facility. It may be said, that they are accus- 
tomed to morbid action. Their animal powers are trained 
to battle ; insomuch, that morbid action is the ordinary state 
of their blood-vessels, and unnatural distension their ordinary 
condition. And hence, probably, the danger of bleeding 
them under common circumstances. Habitual distension has 
deprived the arteries of their elasticity, and probably of their 
natural sensibility: consequently, they require unnatural dis- 
tension in order to keep the capillary vessels supplied. There 
is danger of an immediate sinking into a state of irrecovera- 
ble prostration, or of mania a potu. 

After an inflammatory affection shall have determined in 
suppuration, it is ordinarily improper to repeat blood-letting. 
In an instance of angina tonsillaris, for example, blood-letting 
after the commencement of suppuration, serves only to retard 
its progress. As the arteries are the agents in the secretion 
of pus, the reduction of their action tends to retard the pro- 
cess. In applying this as a general rule, regard must be had 
to the state of the system : for it is also possible, that the 
arterial action may be too strong for a kindly suppurative 
process ; and then blood-letting wotdd be particularly useful. 

In pneumony, after a copious expectoration shall have 
taken place, further blood-letting is unnecessary. But if 
coughing be again attended with pain, and there be a recur- 
rence of a tense pulse, or of difficult and sparing expectora- 
tion, blood-letting must be resumed. 

Blood-letting may be dispensed with, in cases of disease, 
whose progress is such as to afford the necessary time to 



WHEN THE LANCET SHOULD BE CAUTIOUSLY USED. 131 

wait for the indirect or circuitous effects of purging and ab- 
stemious diet. It requires circumspection, however, to guard 
against mistake. If we give intimation on the first visit to a 
patient, that recovery may be expected from the use of very 
mild remedies, and it shall turn out, that we have erred in 
our ^idgment, possibly when too late, we shall be driven 
to the use of the lancet and other potent remedies, it might 
prove highly injurious to the profession. 

When we discover a great and constitutional dread of the 
operation, and there is no good evidence of danger to life 
from the omission of blood-letting, in most instances, it would 
be prudent to avoid it. 

Sometimes the effect of the operation on the nerves of the 
patient may be serious. We once saw a child alarmed into 
instantaneous convulsions, fr6m being bled with a spring lan- 
cet when asleep. We say, in course, let the patierit be 
awake. 

It is commonly thought that the appearance of sizy blood 
invariably warrants a repetition of blood-letting. But this is 
certainly an erroneous opinion. We have so often seen the 
contrary, and have so constantly found it necessary to regu- 
late our practice by other and better guides, that we seldom 
ask the attendants to preserve the blood for our subsequent 
inspection. In fact, after the fourth or fifth and ordinarily 
the last necessary bleeding, in case of pulmonitis or rheuma- 
tism, the buffy appearance is very commonly more conspicu- 
ous than before. In autumnal fevers it will be found, com- 
monly, that one bleeding is sufficient, and yet in most in- 
stances, the blood will be buffy. The same thing occurred 
under the observation of Sir John Pringle, in the hospital 
fever ; and in some instances the blood will put on that ap- 
pearance when drawn from a patient in consumption a few 
hours before death. 

A tense pulse does not always call for the use of the lancet. 
Perhaps every case of incurable tuberculous consumption 



VS'Z WHEN THE LANCET SHOULD BE CAUTIOUSLY USED. 

will be attended by an incorrigibly tense pulse. In cases of 
this sort, we may repeat the blood-letting however often, and 
no improvement will be gained as to the state of the pulse. 
There are also instances of affections of the head and of the 
liver, in which the tension of the pnlse is equally unconquer- 
able by blood-letting. In either of these cases, the repetition 
of the remedy, must be regulated by other indications beside 
a tension of the pulse. And when the physician keeps the 
watch with the necessary care, he will be able to judge of 
the presence or absence of plethora or of the arterial force 
which will justify blood-letting. In deciding this matter in 
any such case, regard may be had to the quantity of food 
taken daily, the efficiency of the blood-making organs in the 
process of digestion, &c. but particularly the success with 
v/hich the loss of blood is repaired. Without triis kind of 
circumspection, the life of the patient may be improperly 
shortened. 

There are instances in which the sensorial influence is 
morbidly directed upon the arterial system, apparently at the 
expense of the absorbents : — the pulse is tense from the be- 
ginning of such cases, to their termination in death. Such 
is the fact, sometimes, when great and alarming hemorrhages 
occur. If the patient be of the lymphatic temperament, and 
having much flesh, this will be the case, probably, in any in- 
stance of hemorrhage to which such persons may be liable. 



BLOOD-LETTING IN PREGNANCY, ETC. 133 



CHAPTER XIY. 

ON THE USES OF BLOOD-LETTING IN CASES OF PREGNAN- 
CY AND PARTURITION. 

Having at length brought to a close the general therapeu- 
tic principles and precautions, in respect of blood-letting, we 
we shall now briefly invite attention to some remarks on the 
application of the remedy to some diseases, which are con- 
sidered to belong to the class of fevers and which we may 
not have an opportunity to notice, sufficiently, in any other 
place. 

In pregnancy it is" often necessary, and is too commonly 
omitted. All the considerations whieh concur to prove the 
necessity of bloodletting in diseases of the viscera, apply to 
pregnant women, and much more; because of the incessant 
and continually increasing mechanical pressure, made by the 
growing foetus. When we have been introduced into an in- 
timate acquaintance with the affections and sufferings of the 
fair mothers of mankind, we hear of the many precautions 
against taking cold in child bed. Puerpal fever is almost 
without exception, consequent upon a diseased state of the 
viscera, produced by pressure and constipation. An inflam- 
mation of the uterus alone, is a very rare affection. We have 
not seen it more than ten times in thirty years. Even when 
fever has occurred to lying-in women six weeks after partu- 
rition, we have been able to retrace its predisposing cause, to 
the mechanical pressure and constipation j to effects of pres- 
sure made by the foetus. Perhaps he ought to add, that the 
kmd of pressure of which we now speak, very commonly. 



134 BLOOD-LETTING IN PREGNANCY, ETC 



like certain chronic affections of the liver, or diseases of the 
mesentery, is accompanied with a sensation like hunger, on 
account of which, the patient is lead to eat inordinately. Af- 
ter continuing this practice for a season, she complains of feel- 
ing empty if she do not eat very frequently ; and this contin- 
ued inclination to eat ? serves to beguile the unsuspecting vic- 
tim, till the injury sustained by fullness and pressure, be- 
comes incorrigible. It is attended, however, by daily head- 
ache, -cholic, lassitude, and frequently by pains in the lower 
extremities j and as the danger increases, by thirst, restless 
nights, alarming dreams, and great fears as to the issue of 
parturition. In every such case, frequent bleeding, aided by 
appropriate cathartics, are indispensable, and if well conduct- 
ed, are almost infallibly sure of success. 

These remarks go to show, that almost any disease which 
is commonly treated with blood-letting, will therefore re- 
quire it more abundantly when it occurs to a pregnant wo- 
man. The well known practice in eclampsia is one instance 
in proof of the correctness of this remark. 

After having so strongly encouraged blood-letting in cases 
of gestation, perhaps, we ought to add by way of precaution 
that there are instances of an opposite or reverse character, 
which would be injured by blood-letting, and which require 
the regular use of cordials; taking an occasional dose of 
castor oil, or magnesia, or sulphate of magnesia, as it may 
be found by experience, best to suit the patient. Parturition ? 
when it is marked with convulsive or clonic action in the 
uterus, and is accompanied with chills, heat, thirst, a quick, 
full, tense, or a frequent and depressed pulse, and great pain, 
is a disease of serious importance, and requires blood-letting 
and evacuation of the bowels. The labor will not progress 
kindly, until the system shall have been thus aided by the 
necessary evacuations. But we do not consider parturition, 
in its perfectly natural state, to be a disease. We have seen 



ETC. 135 

it occur under circumstances, very moderately inconvenient ; 
and the woman has been able to rise the next day. It is 
known, that in the Brazils, Calabria, and some parts of Afri- 
ca, it is scarcely regarded. The Turkish women too, by a 
very free use of sweet oil, reduce their systems to a degree 
of convenient relaxation, so as to make it a small matter to 
bring forth their children. We have been credibly inform- 
ed, that women who having removed from the North to the 
States of Missouri and Mississippi,, have found a very great 
difference in their favor. The rigidity therefore, which makes 
parturition difficult, and which seems to be the result of cli- 
mate and manner of living, together with the consideration 
in respect of the inevitable mechanical pressure which has 
been already noticed, are the causes which produce the ap- 
pearances of disease in parturition. If the system be already 
predisposed to fever, and is compelled to struggle long and 
hard, with a rigid os tincce. and os externum, the reiterated 
struggle will produce fever ; and the degree of fever will be 
in proportion to the extent of these two particulars. When it 
is considered, that parturition is always attended with un- 
common facility if the patient has been previously ill with 
some disease which has required copious blood-letting, espe- 
cially if a short time only before lying in, and that those ap- 
pearances which call for blood-letting in other circumstances, 
would report it doubly necessary in any case of parturition, 
it is presumed, that we shall feel the necessity of meeting ap- 
pearances of disease in any such instance with the necessa- 
ry decision. That is to say, we would take sixteen to 
twenty or thirty, or even eighty ounces of blood, keeping 
in recollection the precautions which are proper in other 
diseases. 

Inanition, langour, and feeble morbid action, require cor- 
dials, opium, <^c. 

The ordinary prepossession or fears of the patient^ may 



136 BLOOD-LETTING IN PREGNANCY, ETC. 



commonly be removed by giving her a proper account of 
the necessity of the practice, or of the happy effects it will 
be likely to produce in lessening her pains ; for it may be 
stated with confidence that it will facilicate labor : prevent 
or moderate the after-pains j be favorable to a kindly secre- 
tion of the milk ; prevent sore breasts, swelled limbs, child- 
bed fever, and all the train of nameless complaints, that too 
often follow child-bearing, where this useful measure of de- 
fence shall have been neglected. 



MISCELLANEOUS ON BLOOD-LETTING. 137 



9 CHAPTER XV. 

MISCELLANEOUS ON BLOOD-LETTING. 

There is a period of life, common to most women, when 
the menses are said to dodge • — that is, to make their appear- 
ance irregularly, as to the time of their recurrence, and the 
time of their periodical duration ; and again for a few years 
after the menses disappear, when there is a morbid fullness 
and disposition to irritation in the blood-vessels, which re- 
quires attention. If such patients'are not depleted by blood- 
letting or otherwise, they are liable to great inconvenience 
from head-ache, troublesome coughs, hemorrhages, dropsy, 
schyrri, cancers, &c. 

The disease produced by an over-dose of opium or stram- 
monium, would probably be more certainly relieved by 
blood-letting than by other means, not forgetting the propri- 
ety of first endeavoring to evacuate the offending article by 
vomiting, or if convenient, by the pump or stomach syringe. 

We relieved two cases of spider bite, in the persons of two 
ladies in Virginia, forty years of age, by very copious blood- 
letting. 

Diabetes has been cured by blood-letting. This affection 
has commonly been considered to be local, and a disease of 
debility. In conformity with this opinion, it has been treated 
with stimulating and tonic remedies. A physician with good 
experience and an accurate acquaintance with the pulse, will 
be able to discriminate such cases as require blood-letting. 

When intermittent fevers have long resisted the use of 
quinine and all the tonic and stimulating remedies, ordinarily 
resorted to in such protracted cases, bleeding will commonly 
be found effectual. It has been a common practice in the 



138 MISCELLANEOUS ON BLOOD-LETTING. 

hospital of Pennsylvania, and we have proved its value in 
many instances. 

The efficacy of blood-letting in preparing a patient for a 
more ready reduction of a dislocated femur or humerus is 
now as well understood as any other fact in surgery. The 
same principle is found to hold good in bleeding to deliquium 
as the principal preparatory measure, before an attempt to 
turn the foetus in an arm presentation, when the constriction 
of the uterus is so rigid, as to render the turning apparently 
impossible. 

Blood-letting is one of the great general remedies, which 
is never to be considered associated with the name of any 
disease. Whenever the arterial action is such that it mate- 
rially transcends the corresponding action of the veins and 
lymphatics, and at the same time gives evidence by the ten- 
sion and incompressibility of the pulse, that there is a morbid 
determination of the sensorial influence upon the heart and 
arteries, then more or less blood-letting will be useful j often 
it will be found indispensible. 

We have dwelt largely upon this subject, because, we 
know how much depends on being well acquainted with it. 
When we first set out in the practice, it was known only as 
other particular agents are known to the nosologist; and 
when we first heard of the general use which was likely to 
be made of it, it seemed to us almost incredible. But at 
length, testimony supported philosophy, and we were com- 
pelled to admit the fact, that it might be employed as one of 
the great general agents, to an indefinite extent. No one, 
but such as have felt the embarrassment which is inevitable, 
when we are under the necessity of feeling after our own way 
without a guide, in conducting our inquiries and experience 
in regard of an agent which admits of so extensive an appli- 
cation, can tell how much we would have prized a system of 
instruction, such as can now be furnished ready to the hand 
of the student of medicine. Having felt the want of it, we 



MISCELLANEOUS ON BLOOD-LETTING. 139 

know its importance, and therefore have taken pains for his 
benefit. Ana before a young physician shall have been one 
year engaged in the practice, he will have ascertained, that 
the great value of the remedy, is worth all the pains of com- 
municating therapeutics concerning it, and all the time and 
attention necessary for acquiring the information requisite for 
its appropriate use. The more frequently he shall have oc- 
casion properly to prove its worth, the more highly he will 
prize it. The longer he shall have opportunity to satisfy 
himself of its almost universal fitness, to a greater or lesser 
extent, to almost every patient and in almost every disease, 
the more highly he will appreciate the memory of our great 
and excellent countryman, and the father of American medi- 
cal science. If then we have fairly and truly represented this 
incomparable remedy in the practice of physic, and shall 
have succeeded in producing a corresponding zeal in our 
readers to make themselves masters in this particular, we 
shall have no hesitation in taking it as a sure omen and 
pledge, of their dignity in the profession, and of their success 
in the practice. 



140 APPEARANCES OF THE BLOOD, ETC. 



CHAPTER XVI. 

ON THE VARIOUS APPEARANCES OF THE BLOOD WHEN 
SET TO COOL AFTER BLOOD-LETTING. 

When blood-letting shall have been performed, some use- 
ful information is to be gained, by inspecting the appearance 
of the blood, as to the propriety of repeating the practice. 

Dissolved blood. This occurs in malignant fevers ; we 
have seen it several times in pulmonitis : and once in an af- 
fection like a rheumatism. This appearance has been as- 
cribed by Dr. Rush, to such a violent or feeble degree of 
action in the blood-vessels, as to dispose them to a paralytic 
state. We are not prepared to adopt this opinion, being 
inclined to think with some of the ablest physiologists, that 
the arteries, particularly those with large diameters, have but 
little other action beside that consequent on their- expansi- 
bility and contractibility: and that the dissolved state of the 
blood depends much more on the manner of its elaboration 
and the velocity of its circulation, than upon the mere action 
of the blood-vessels. It was formerly considered as a signal 
to lay aside the lancet. But if it occur in the first stage of a 
fever, it indicates an opposite practice. After repeated mod- 
erate blood-lettings, the viscera recover their functions, and 
the blood is in some degree repaired or reduced to its natural 
texture. If the same appearance occur towards the close of 
a malignant fever, it is indicative of a fatal termination : and 
although the pulse be tense, blood-letting may do no good ; 
the capillaries of the viscera are generally so much congested 
by the continuance of the morbid action, that they are not 
able to retire the blood which distends them. After much 
attentive observation, we have been compelled to adopt this 



ETC. 141 

last expressed opinion, respecting the permanent distension of 
the vessels of the viscera, which may be so great as to destroy 
their vitality; and the consequent delay of the blood serves 
to deteriorate its condition ; whilst the distended vessels ap- 
proximate to gangrene and produce a coagulation of the blood 
in the tissues which terminate in the injured mass. (See 
Hunter on the Blood. ) The appearance of dissolution in the 
blood, threatens most danger to life, when it resembles mo- 
lasses in its consistence. The danger is less, when the part 
which is dissolved occupies ..the bottom of the bowl, and 
when the surface is covered with a sizy pellicle or coat. 
That is, if the circulation be imperfect, past recovery, and 
the viscus or viscera principally affected be on the verge of 
gangrene, the blood will not carry the appearances of any 
remaining disposition in the particles which combine to form 
coaguiable lymph, to stir themselves to take on that appear- 
ance. The blood will be an inert, crude fluid, resembling 
molasses. But so long as the blood-making organs retain 
their essential function, although there may be delay, and 
the particles tending to the state in which vitality is lost, still 
there is enough of life remaining, to take on the sizy pellicle. 
When the suffocation which occurs in the early stage of fe- 
ver, in which alone these appearances of the blood justify 
blood-letting, and the condition of the blood is corrected by 
depletion, that is, by lessening the quantity, the. blood is 
more perfectly circulated, being better elaborated for assimi- 
lation. 

Blood of a scarlet color, without any separation into cras- 
samentum or serum, indicates a moderate degree of inflam- 
matory action. This is likewise seen in malignant fever. It 
has been called dense blood — improperly however. The 
same appearance occurs in old people. It proves therefore 
an imperfect elaboration, such as occurs antecedent to the 
stage which exhibits dissolved blood. 

Red or green serum. These appearances depend on the 



142 APPEARANCES OF THE BLOOD, ETC. 



condition of the liver, and the consequent result of deficiency 
in the functions engaged in the elaboration of the blood. 

Another degree of morbid action is specified by a crassa- 
mentum sinking to the bottom of the bowl in yellow serum. 

Another exhibits a floating crassamentum, which is at first 
turbid, but which afterwards becomes transparent, depositing 
fiery looking particles. 

Another exhibits sizy blood, or blood covered with a buffy 
coat. If the crassamentum take on the form of a cup, it is 
significant of more inflammatory action, and is common to 
all inflammatory fever ; to mild cases of malignant fevers and 
towards the close of fevers that have been violent. Such 
appearances in yellow fever after an abatement of dangerous 
symptoms, are favorable. Blood resembling claret when it 
is flowing, is commonly buffy when cool. 

Dr. Rush thought, that the power of coagulation of the 
blood, was lessened in an exact ratio to the increase of the 
action of the blood-vessels ; and that it was increased, in 
proportion to the diminution of that action. These remarks 
were made by the Doctor, in view of his favorite theory, that 
a morbid action of the blood-vessels is the proximate cause 
of fever. But we must never lose sight of the great and im- 
portant truth, that a morbid condition of some viscus or other 
important structure, must be coexistent with the morbid ac- 
tion of the blood-vessels ; — perhaps in most instances, must 
first exist, before the morbid action which is the effect of irri- 
tation can ever occur. Besides a morbid condition of the blood 
or other fluids, must necessarily be concomitant with a mor- 
bid action of the blood-vessels ; and possibly the former may 
be the proximate cause of the latter. 

It has been supposed, that an appearance like dissolution 
of the blood, or lotio carnium, also that the absence of an 
inflammatory crust, afforded evidence that blood-letting in 
such cases is injurious. These appearances do not occur in 
the first attack of fever ; in fact they never occur if the cir- 



APPEARANCES OF THE BLOOD, ETC. 143 

dilation through the blood-making organs, be sufficiently 
active and free. But when the arterial structures have been 
long irritated, and the blood has been prevented from circu- 
lating freely through the lungs and liver, a tendency to the 
state of things which is marked by this appearance com- 
mences, and if not corrected by blood-letting, the complete 
expression of lotio carnium, will quickly follow. It is an 
interesting fact, however, that if the blood in such a case be 
drawn at short intervals, say two or three ounces, every five 
minutes, till it be drawn four or six times, two or three ounces 
in each of four or six small cups, we will have as may differ- 
ent appearances of the blood, as we have cups. It is also a 
fact, that in this respect, much will depend on the freedom 
of the orifice, that is, the velocity with which the blood is 
permitted to flow. When this state of things, occurs, how- 
ever, we do not succeed in obtaining a very free discharge, 
even if the orifice be well opened. The capillary veins are 
too rigidly constricted, to afford a very full stream. If drawn 
in the ordinary way, there will be an obvious arterial force 
with heat of the skin ; and so far is it from being improper to 
use the lancet under such circumstances, it is not easy to 
describe a case in which blood-letting is more imperiously 
necessary. 

As to the absence of the inflammatory crust, perhaps it is 
always absent on the first bleeding, provided the practice be 
performed within a few hours after the commencement of 
any sudden attack of fever. A patient, whose blood when 
drawn under ordinary circumstances and in the common 
way, would be marked with a very strong buffy coat, if 
placed for ten or fifteen minutes within the influence of a 
sufficiently hot bath, and then bled, will furnish an exhibi- 
tion of blood, nearly as florid as arterial blood ; and almost, 
if not altogether, without the white crust on the crassamen- 
tum. This fact goes to prove, that, so soon as the arterial 
action begins to be tense and irritated, the blood begins to 



144 APPEARANCES OF THE BLOOD, ETC. 

be imperfectly circulated through the blood-making organs 
— of course, every moment afterwards, this all-important fluid 
is becoming less and less fitted for supplying to the several 
parts of the body those particles of pabulum, necessary for 
the support of the solids, or those etherial influences, requi- 
site for maintaining a proper condition of the sensorium and 
nerves. To let blood in the early stages of fever, must al- 
ways be useful, and in those circumstances, when the arterial 
action is locked up and tense, it is commonly indispensable, 
in order to preserve life till the functions which have been 
thrown into disarray, shall have had time to return to order. 
The effect of the hot bath in changing the color and condi- 
tion of the blood, affords evidence in proof that the skin per- 
forms a function in aid of the lungs, in maintaining its 
healthful state. 

It has been supposed, too, that an undue proportion of se- 
rum to crassamentum in the blood, ought to be considered 
as premonitory of the necessity of staying the use of the lan- 
cet. It is a fact, that when this state of things occurs after 
frequent blood-letting, it affords one of the most certain 
proofs, -that the practice may be. fearlessly repeated } if the 
state of the pulse, and other indications calling for it r should 
continue to recur. That state of things which we denomi- 
nate an inflammatory diathesis, an irritable state of the arte- 
ries, very often becomes chronic. And frequently after hav- 
ing disappeared for a while, it is revived by any casualty 
which may serve to excite the arterial system, such as the 
use of a little wine, or an ounce or two of improper diet : — 
even too much company or attention to business. In such 
cases, if blood-letting at the commencement and a repetition 
of it shall have been necessary, it will be found equally ne- 
cessary, on the recurrence of the irritation, to repeat the 
practice. 

It was once thought improper to bleed a patient in pul- 
monitis, then called pleurisy, after the fifth day. No doubt 



ETC. 145 

this opinion gained its currency, when the theory prevailed, 
which taught physicians to have a careful respect to nature's 
operations in preparing and expelling morbific matter from 
the system. Modern experience, has corrected this mistake. 
It is now known that blood-letting may be repeated with de- 
cided advantage, as long as the pain and a tense pulse con- 
tinue. Indeed a proper understanding of the circumstances 
which constitute the danger of this disease, will fix the con- 
viction, that the last blood-letting, if on the tenth day, is as 
necessary as the first. 

In some instances, when this practice is clearly indicated 
and under circumstances well understood to call for decisive 
blood-letting, we must not be deterred because the patient 
seems to be worse after the first or second blood-letting. 
When the system has been greatly depressed, the sudden 
relief afforded by the abstraction of blood, so completely sets 
the circulation at liberty, that in a very short time, the arte- 
rial action overruns the absorption of. the capillaries, and a 
tense injection of the pulmonary arteries or those of some 
other organ, very soon follows. And as the circulation be- 
gins to lock itself up,, the patient will begin to feel chilly. 
which may soon be followed by heat, delirium, hemorrhage, 
convulsions, nausea, fainting, pain, &c, with a tense pulse. 
If these appearances should be so far mistaken as to lead to 
the use of wine, opium or other cordial remedies, the conse- 
quence may be fatal. So far indeed is this kind of treatment 
from being, correct, the greater the apparent weakness in 
such a case, the greater the necessity for further loss of blood. 
In such circumstances,, cases sometimes occur, in which at 
the same time that pain and. other appearances clearly indi- 
cate the necessity of blood-letting,, the state of the pulse 
might seem, to forbid it. By a soft and apparently harmless 
pulse, the unwary physician might readily be led to have re- 
liance on a cathartic or emetic, or some other remedy. At 
length, however, when driven to the use of. the lancet, he will 
10 



146 APPEARANCES OF THE BLOOD. ETC. 

be surprised to find, after a bleeding or two, this soft and in- 
offensive pulse becomes very tense and threatening. 

Bleeding is often used very sparingly or avoided altogether 
in autumnal fevers, for fear of bringing on a typhus or chro- 
nic state of fever. A sparing use of the remedy is indeed 
very apt to be followed by such appearances, because the 
imperfect use of the remedy fails to correct the inflammatory 
diatheses of the blood-vessels, and when left to wear itself 
down by time, there is no just cause to complain, because it 
requires time enough to do the work. We can conceive of no 
way, by which blood-letting can have a tendency to produce 
a protracted state of disease, save only, an omission of the 
means necessary to secure a sufficient and permanent excite- 
ment of the skin. Patients of a nervous or lymphatic tern, 
perament, most emphatically need attention in this particular. 

Objections are sometimes raised against blood-letting, be- 
cause it is thought to weaken the patient. This objection 
is purely the effect of ignorance of what takes place in the 
animal economy, when this practice is made necessary. For 
it is the fact, that the chief merit of blood-letting, consists in 
its instantaneous power to induce as much debility, as the 
case can demand. Other agents are too slow in producing 
their effects, and before their indirect action can be made to 
bear on the case, the lesion produced by the violence of the 
disease, may be fatal to the patient. There is another con- 
sideration of very great moment. If we rely on other means 
for reducing the power of the feverish action, and especially 
if it should require much time, there must necessarily be 
produced a proportionate degree of prostration, such as would 
involve the power of the sensorium and the condition of the 
blood. Blood-letting will enable us to secure an equal de- 
gree of safety, as it respects the desired debility, avoiding the 
danger before noticed, and at the same time maintaining the 
sensorial power, to be employed in effecting the restoration 
of healthy action. 



APPEARANCES OF THE BLOOD, ETC. 147 



We have often been asked if blood-letting, did not 
carry with it the great evil, of bringing about the necessity 
of its habitual use ? That it would be a bad practice to 
eat and drink to excess, so as to induce plethora, and then 
have recourse to the use of the lancet for its correction, there 
can be no question. A repetition of such a practice, 
would bring about the habit which seems to be dreaded, 
and it would be a habit which would soon produce very 
serious consequences. But it must be seen at first view, 
that the objection is worth nothing, when opposed to the im- 
perious demands of a case of inflammatory fever. Besides, 
the time required for the correction of the disease, and for the 
whole course of convalescence, is always sufficient for an 
equable invigoration of the whole system, as well the blood- 
vessels, as the muscles. 

Bleeding in autumnal fevers has been condemned, because 
it is frequently followed by fever in the intermittent form. 
The bare mention of the objection is sufficient to refute it. 
To exchange a violent and dangerous fever, for one that is 
safe and manageable, must certainly be an advantageous 
commutation. Besides there are instances of intermittents 
which defy all known agents, until the inflammatory diathe- 
sis, which constitutes the difficulty, is removed by blood- 
letting. 

The enemies of the blood-letting practice, have said that it 
predisposes to effusion of serum in the lungs, chest, abdomen, 
head, and cellular substance. Our practice and observation 
do not at all accord with this objection. Indeed they have 
convinced us, that the mischiefs referred to, have occurred 
from the want of timely and sufficient depletion ; and instead 
of charging them to the account of blood-letting, they would 
much more justly be ascribed to timidity or want of judg- 
ment, on the part of the practiser ; for no man can know the 
full value of blood-letting, who does not heartily engage in 
its use. Besides, in the application of this remedy, it is im- 



I4S APPEARANCES OF THE BLOOD, ETC. 

portant that a proper regard be paid to the condition of the 
external capillaries ; which done in due time and in an effec- 
tual manner, there is nothing to fear from effusion. Indeed 
we cannot readily conceive, how debility alone can dispose 
to effusion. We have frequently cured dropsies by blood- 
letting and cooling cathartics ; which practice would be 
strangely absurd, if the objection under consideration had 
any real merit. If ever bleeding kills, " says Botallus, either 
directly or indirectly through the instrumentality of some 
other disease," it is not from its excess, but because it is not 
drawn in sufficient quantity, or at a proper time. And again . 
in another place, he says " one hundred thousand men perish 
from the want of blood-letting or from its being used out of 
time, to one who perishes from too much bleeding, prescribed 
by a physician." 

Associations have been formed in cities and country pla- 
ces, predicated on the practice of the aborigines, proposing to 
cure all fevers without blood-letting ; relying on puking by 
means of lobelia inflata, sweating by the external application 
of hot steam,, and the internal use of capsicum, ginger, bar- 
berry bark, &c. That this sort of practice may often relieve 
slight diseases, and sometimes fail to kill patients seriously 
ill, we have no doubt. But we have seen some instances of 
irreparable damage done by it, and no man, at all acquainted 
with anatomy and physiology, could for a moment believe 
the tales that are told about the success of a practice, which 
in every instance of seriously inflammatory character, must 
endanger the life of the patient. As to the Indian sweat, we 
shall take occasion to be understood to entire satisfaction, 
when we come to treat at large the subject of diaphoresis. 
The most potent and popular argument which they pretend 
to offer, is, that the blood is the life, and suppose they have 
defied all contradiction, when they can quote a clause from 
the scripture of truth, in their support. To strengthen the 
prohibition given to the children of Israel by Moses, against 



APPEARANCES OF THE BLOOD; ETC. 149 

the practice of the Gentiles, of eating the blood of animals ; 
he informed them, that " the blood is the life." But there 
is not the shade of an insinuation, that blood-letting is for- 
bidden by the Bible. The position of the veins, and the 
facility with which they are sufficiently strangulated for the 
purpose of conveniently performing the operation, seem to 
invite to the practice. And a proper acquaintance with the 
physiology of the blood-making organs, collated with the fact 
every day exhibited, that the blood is a fluid which is per- 
petually being made, in great abundance, furnishing the ma- 
terial for all the secretions, would of itself be sufficient to 
silence such ignorant pretensions. 



150 QUANTIfY Of EiLOOD, ETC. 



CHAPTER XVIL 

AN" INQUIRY.. RESPECTING THE QUANTITY OF BLOOD 

TFiAT CAN &E SAFELY DRAWN IN ANY INSTANCE 

OF BLOOD-LETTING, AND HOW OFTEN IT 

CAN BE SAFELY REPEATED. 

Our next inquiry will have respect to the quantity of blood 
that may probably be required to be drawn, in any individ- 
ual instance. 

A person of ordinary size, is supposed to contain from 
twenty-five to twenty-eight pounds, and by casualties of dif- 
ferent kinds, one-third of that quantity has been lost at once, 
without hazard. But a greater quantity can be taken with 
safety, when the blood-vessels are in a state of irritation, than 
when in health. If the blood is a stimulant when in its 
healthful condition, and the vessels in a natural state, then 
it is obvious, that a less than natural quantity will stimulate 
sufficiently, when, not only the blood is more irritating, but 
the blood-vessels more irritable, than natural. We know that 
the eyes and ears, are painfully sensitive to a very little light 
and sound, when the system is thus affected. And we know, 
with equal certainty, that under similar circumstances, a very 
small portion of wine will serve to irritate, to an alarming 
degree, even those, who in health are well accustomed to its 
use. We have it recorded in the books, that one man in St. 
Thomas's Hospital, by the advice of Mr. Kline, drew three 
hundred and twenty ounces in twenty days, for a contusion 
of the head. Dr. Haller reports one person, who lost nine 
pounds ; another twelve, a third eighteen, a fourth twenty- 
two pounds, by epistaxis, at one time. Dr. Rush speaks of 
a gentleman at Angola, who lost three and four pounds, per 



QUANTITY OF BLOOD, ETC. 151 

day, in the same manner ; and who was cured by being 
bled ninety-seven times, in one year : of a young woman, 
who was bled one thousand and twenty times, in nineteen 
years, to cure her of a plethora, which disposed her to hys- 
teria ; and of another who lost one hundred and twenty-five 
ounces of blood, by an hemorrhage, every month. To cure 
this she was bled every day, and every second day, for four- 
teen months : and they all recovered. We bled a lady one 
hundred times in four months ; sometimes four ounces — 
sometimes more at each time for an inflammatory disease of 
the head ; she recovered. We bled a maniac one hundred 
times in six months, three times two pounds ; often a pound 
and seldom less than half a pound at any one time. He 
became anasarcous to a moderate degree, when the blood- 
letting was laid aside. He ultimately recovered. 

Dr. Sydenham, vol. 1, page 131, says " among the other 
calamities of the civil war which affected this nation, the 
plague also raged in several places, and was brought by acci- 
dent from another place to Dunstan Castle, in Somersetshire : 
where some of the soldiers dying suddenly with an eruption 
of spots, it likewise seized several others. It happened, that 
a surgeon who had traveled in foreign parts, was in the ser- 
vice there, and applied to the governor for leave to assist his 
fellow soldiers, who were afflicted with this dreadful disease, 
in the best manner he was able ; which being granted, he 
took so large a quantity of blood from every one, in the be- 
ginning of the disease and before any swelling was perceived, 
that they were ready to faint and drop down ; — for he bled 
them all standing, and in the open air, and had no vessel to 
measure the blood ; which falling on the ground, the quan- 
tity which each person lost of course, could not be known. 
After the operation he ordered them to lie in their tents, and 
although he gave them no kind of remedy after the bleeding, 
yet of the numbers that were thus treated, not a single per- 
son died. I had this relation " says the Doctor, from Col. 



152 QUANTITY OF BLOOD, ETC. 

Francis Windham, a gentleman of great honor and veracity, 
and at this time governor of the castle." 

It may be remembered too, that blood is rapidly regenera- 
ted. "A person," says Haller, "lost five pounds a day from 
the hemorrhordal vessels, for sixty-two days j another sev- 
enty-five pounds in ten days. We have recited these nume- 
rous facts, supported by the best authorities, and added our 
own testimony, to prepare the reader to use the necessary 
decision in the employment of this important remedy; and to 
show, that a timid or even a moderate practice in its use, 
ought not to be relied on. From our own experience we are 
sure, that half-way measures will generally disappoint. It is 
better not to bleed at all, than to ttop short of the quantity 
which shall be proportionate to the violence of the case. We 
must be prepared to judge by the pulse and other appear- 
ances, and then remember that in blood-letting, as in any 
other enterprize or undertaking, the value of it is known only, 
when it is consummated. Whoever desists in administering 
cathartics in a colic attended with constipation, until he has 
succeeded in opening the bowels ? For similar reasons the 
bleeding should be repeated, so long as, the indications requi- 
ring it, continue to return. And we will add, that the con- 
valescence is always more complete and speedy, when the 
practice has been sufficiently decisive. 

But it is also proper to graduate the quantity drawn at any 
one time, in any case, according to the state of the system. 
When the pulse acts with force and freedom, from ten to 
twenty ounces may be taken at once, in any ordinary case : 
if the pulse be depressed, it is commonly better to take a few 
ounces at a time, repeating the operation three or four times 
a day. By this method the blood-vessels are gradually re- 
leased, and the inconvenience of a shock is avoided. This 
method or something like it, would commonly be safest in 
fevers when the pulse is tense, but when the character of the 



QUANTITY OF BLOOD, ETC. 153 

fever is not sufficiently known, the quantity may be regula- 
ted according to circumstances. 

In fevers and other diseases whose type and character are 
known, and which run their courses in a few days, or hours, 
threatening speedy destruction, there can be no limits previ- 
ously fixed, as to the quantity of blood which may be drawn 
at once, or in one day. In such cases, Botallus drew four or 
five pints in a day. Every physician of good experience, 
does that or something like it in every case of eclampsia 
which comes under his direction and management. Dr. 
Jackson drew fifty-six ounces at one time, from a patient in 
one of the British hospitals, in a fever of great danger. This 
patient was instantly relieved • — in three or four hours, was 
out of danger ; — and in three or four days returned to duty. 
It is stated in Philadelphia, that Dr. Physick drew from Dr. 
Dewees, ninety ounces at once, in an attack of apoplexy. It 
was so effectual, that he was able to return to business in a 
few days afterwards. In any instance of violent disease of 
recent origin, and threatening danger to some one vital organ, 
we have so often found it important to bleed to deliquium, 
that we deem it necessary to inculcate the practice. The 
rationale of its good effects has been given in a previous 
chapter : but this decisive method should never be employed 
in the advanced or the last stages of fevers. The system 
under any circumstances requires all its resources of sensorial 
energy, to rouse it from a fainting fit ; and such requisite 
stock of energy, does not always exist, except at the onset of 
disease. In chronic fevers of an inflammatory type, however, 
small bleedings may frequently be repeated with great ad- 
vantage. The benefit of this practice, is perhaps too little 
known. And it will require a degree of vigilant attention 
and patient observation, which too few are disposed to make, 
to gain the necessary judgment in its use, so as not to be 
liable to mistake. All medical men who have any preten- 
sions, use mercury and antimony, and dietetic management. 



154 QUANTITY OF BLOOD, ETC. 

with alterative intentions. Before this kind of practice can 
be successfully employed, there must be acquired a maturity 
of judgment in respect to those particulars, similar to what 
is here recommended, in regard of blood-letting, as an altera- 
tive practice. A proper consideration of its physical effects 
on the circulation, and the ultimate result in regard of the 
laws of absorption, we have thought, ought to be satisfac- 
tory. We use the cold bath in some chronic affections, but 
never expect that two or three immersions will effect a cure. 
We persist in its use for months and years. So also we 
must do, if we have recourse to blood-letting as an alterative 
agent. It should be repeated, while the symptoms which 
first indicated it, continue, however often, or to whatever 
amount of loss of blood, it may be found necessary to carry 
the practice. And even in those cases, which do not admit 
of cure, and of course, where the bleeding is to serve only 
as a palliative remedy, it is equally comfortable to the patient, 
and ought to be employed with the same diligence, as if it 
were expected to be perfectly effectual. 

Formerly, great importance was given to the place from 
whence the blood was drawn. It was taken from the foot 
in order to excite revulsion from the head or breast. But 
this is inconvenient on account of the position of the patient. 
It is more dangerous on account of the greater liability to 
wound a tendon. And if it be important to review the work 
by inspecting the blood, it will not be practicable. 

The pulse is to be considered as the chief indication, " the 
dial plate of the system." It ought therefore to be studi- 
ously observed in health and sickness, in the old and young, 
and in all throughout all the seasons of the year, still contin- 
uing the observations with untiring attention, until a sound 
judgment shall have been formed. For it must be admitted, 
after all that can be said or written on this important topic, 
that every physician must be eventually prepared to judge of 
the pulse in his own way; he must adopt his own method of 



QUANTITY OF BLOOD. ETC. 155 

associating his auxiliary considerations, and mark out his 
own points of discrimination to guard him against mistake. 
And let us here reiterate the admonition respecting the great 
importance of forming, what we take the liberty to call, a 
current judgment, respecting the effect of the seasons, in 
producing or maintaining a state of things, which calls for 
blood-letting, when the pulse does not report it, as at other 
times. We dwell on this, because not only our success in 
many cases, depends on it, but what is more imperious, the 
preservation or loss of many lives will be involved in our 
ability or disability to make the discrimination. This will 
be found difficult for a time, but perseverance will overcome 
all difficulty, and the complacency of feeling, which will be 
our constant companion, when the desired point shall have 
been gained, will more than compensate, for all the most 
painful attention which may have been necessary for its 
accomplishment. 



PAET II. 



THERAPEUTICS. 



PART II. 



CHAPTER I. 
INTRODUCTORY TO THERAPEUTICS. 

Therapeutics has now become a science. For ages it 
remained an embryo, germinating in the crude accounts of 
diseases which fancied medicaments were supposed to cure^ 
and was cherished by numerous tales of the wonderful effects 
which those medicaments were said to produce. 

Incipient principles and doctrines were collected from the 
faragos of empyricism, which were recorded in numberless 
recipes of heterogenous compounds. Ignorance had planted 
it in the wilderness and endeavored to promote its growth, 
by collecting around it a chaotic accumulation of substan- 
ces, which were considered important on account of such 
specific virtues, as imagination or experience had associated 
with their names. 

To the last and present century we are indebted for the 
systemmatic arrangement of the principles and reasonings, and 
the classical disposition of the materials, which now sustain 
its claims to scientific dignity. 

In presenting this branch of medical knowledge as a sci- 
ence, we are far from considering it independent of the other 
equally important branches of the profession. Physiology, 



160 INTRODUCTORY TO THERAPEUTICS. 

pathology, and therapeutics, have so near a relation, so in- 
separable an affinity to each other, that their nomenclature 
ought to be formed with a careful reference to the same ana- 
tomical roots, and their doctrines should so accord as to show 
their identity of purpose. But the insulated character of too 
many treatises, which even now occupy places in our libra- 
ries, intended to give instruction in these several branches, 
has been such, that they might be read with ordinary atten- 
tion, and the reader fail to obtain a clear perception of the 
important truth, that between the organs and functions of 
the human body, the diseases to which they are liable, and 
the modus operandi of medicines calculated to heal these 
diseases, there exits an analogy, the knowledge of which con- 
stitutes the only sure guide of the physician. This embar- 
rassing defect will be corrected : and the fundamental princi- 
ples of medicine will assume an harmonious and settled form. 
Anatomy has been laboring to establish the identity of the 
Structures, as they exist in the human body : physiology, 
that of its various functions : and pathology, that of the laws 
by which its diseases are governed. All these branches ac- 
knowledge the near affinity of their several departments,, and 
in their mutual dependence are approximating to the- desired 
maturity. Their well known reciprocity of interest, has 
already served to procure for each a perfection, which nei- 
ther of them, had it been cultivated separately, would ever 
have received. And all these, thus mutually engaged, are 
contributing largely, with intention to give an equal eleva- 
tion to therapeutics, in the attainment of a corresponding cer- 
tainty in the cure of diseases. 

In contemplating each branch of our profession as a dis- 
tinct science, Ave understand, that a suitable acquaintance 
with any one of them, implies a comprehensive view of the 
whole, and that each may be considered as one chapter of a 
great work, of which the principles, the plan and the execu- 
tion are every where unique. Of course, a division of the 



INTRODUCTORY TO THERAPEUTICS. 16 i 



great whole is necessary only in the study of the healing art. 
By this method, we are enabled to submit to the attention of 
the student, in a suitable succession, the different elements of 
which medical knowledge is composed. And although each 
elementary branch, in its place, may alternately seem to as- 
sume a superior degree of importance, this illusion will van- 
ish away, as his mind shall be prepared to comprehend the 
entire system, in the conformation of which, each department 
is employed. He will then be pleased to see, that whilst 
anatomy investigates the structure and relative situation of 
all the organs or parts of the human body; physiology makes 
observation on those organs or parts, in their healthy state : 
and detects the laws under the direction of which, their regular 
functions are performed; pathology examines the causes 
which disturb the order of those functions, setting up amor- 
bid action in the organs or altering their structure, and de- 
scribes the phenomena which attend upon those disturbances 
and changes ; and, therapeutics, after having availed itself of 
all these preliminary investigations, proceeds to ascertain and 
establish the indications, by which, the physician is to be 
guided in his attempts to restore regularity to the system 
when disordered, and health and order to any function or 
organ which may be the seat of disease. 

Therapeutics therefore, requires a consideration distinct 
from materia medica, as well as from the other branches, both 
in regard of the object of its research, and the end which it 
proposes. Whilst materia medica is employed in collecting 
and describing such substances as are useful to the physician,. 
and with the aid of chemistry and pharmacy is making him 
acquainted with the physical character, chemical combination, 
or pharmaceutical composition necessary to arm them with 
the greatest degree of activity, therapeutics is making obser- 
vation on the diseases, and ascertaining the phenomena and 
concomitant principles, by which the physician is to be gui- 
ded in the use of the medicines which the particular case 
11 



162 INTRODUCTORY TO THERAPEUTICS. 

may indicate ; and the utility of which, in similar instances. 
has been established by experience. 

Therapeutics may be said to unite medical science, 
proper, to those branches of physical or natural science, 
which are auxiliaries to our profession. A scientific acquain- 
tance with the immediate or secondary effect of medicinal sub- 
stances, when taken into the system, after a just comprehen- 
sion of the principles which ought to regulate their employ- 
ment as medicinal agents, implies a competent acquaintance 
with anatomy, physiology and pathology. And the truly 
scientific physician will have added to all these, the know- 
ledge which is supplied by the naturalist, the chemist and the 
pharmaceutist. For without these, he cannot properly un- 
derstand the physical qualities, or select the most useful 
preparations of those substances, of which the therapeutist 
advises the use. 

Therapeutics prepares the physician to be a judge of the 
value of any medical intention, or distinctly to perceive the 
occasion which indicates any particular article of medicine, 
or of the comparative merit of an)?- two or more medicinal 
substances. When all the important circumstances which 
pertain to the investigation of any particular case shall have 
been duly examined, and the curative indication shall have 
been discreetly adopted, ultimate success will then depend 
on the therapeutic application of the practice which is to fol- 
low. It remains after all that has been so far done, to select 
the agent ; to judge of the circumstances which are to regu- 
late its employment; to ascertain its appropriate dose: to 
modify the formula most favorable for rendering it useful ; 
the time of repletion ; the effect or evidences by which to 
judge whether it is likely to produce the contemplated inten- 
tion; and if not, the true cause of the failure ; the variation 
of its dose and repetition, as the case progresses. To perfect 
the student of medicine m those attainments which shall en- 
able him in a workmanlike manner, thus to execute his own 



INTRODUCTORY TO THERAPEUTICS. 163 

curative intention, is the particular object and end of thera- 
peutics. 

Disease is a relative state of the human body and is the re- 
verse of health. Therapeutics labors to effect the cure of 
disease, by the restoration of health. To understand what 
pertains to the accomplishment of this object, is to understand 
the circumstances in detail, which are involved in the forma- 
tion of disease, the retirement of which, implies the restora- 
tion proposed ; and a clear discernment of them both, is ne- 
cessary to the therapeutist. In health, the organs essential 
to life, perform their functions with a suitable degree of activ- 
ity and permanence of strength. Their sympathies harmo- 
niously accord ; their demands for sensorial influence, are 
acknowledged in common ; the elaborated fluids which it is 
their office respectively to furnish are duly accomplished ; 
and the most perfect order is maintained, whilst each is en- 
gaged in the performance of its own particular function. 
But when an impression is made by a morbific agent suffi- 
ciently powerful to produce disease, this harmony is discon- 
certed, and a series of actions is produced, which tends lo 
very different results. The physician is called, therefore, 
not to make his observations on a body whose motions and 
functions are all properly performed, with a view to take 
measures for their regular continuance ; but to investigate 
the degree of change and irregularity which may have taken 
place, and by the morbid phenomena and the degree of vio- 
lence and rapidity of the disease, to judge of its tendency to 
destruction. 

But it is not our design in this place to inquire what it is, 
that constitutes disease and its consequent injuries. We in- 
quire how far, the economy of the animal system maybe 
considered as competent to the task of restoring itself. If 
this can be done, we shall be better prepared to judge of the 
extent of artificial interference, which it may be necessary 
to furnish for its aid, in any particular case. 



164 INTRODUCTORY TO THERAPEUTICS. 

We read much about the healing power of nature,* and of 
her efforts in sickness to re-establish health. Hippocrates 
taught and all his disciples received it as truth, that the ani- 
mal organic system is endowed with uphusis. corresponding 
to the Latin, vis medicatrix naturce, by which is meant, an 
inherent power to repel or eliminate morbific agents, and ac- 
cording to modern doctrines to restore regularity to her dis- 
ordered functions. 

In a properly qualified and restricted sense we subscribe to 
this doctrine of the father of medicine. Our experience 
compels us to pay him this homage. But at the same time, 
experience has likewise taught us, that many diseases have a 
constant tendency, so much to derange the organs or tissues 
of vessels on which they act, that without the timely inter- 
ference of art, a ruinous change in the structure of the organs: 
— in many instances, gangrene and death, are the inevitable 
consequences : and diseases less dangerous, if neglected, may 
and too frequently do lead to a state of things, in which new 
and additional injuries are superinduced, more pernicious 
than the original morbid affection. All of which are irresis- 
tible evidences against the vis medicatrix naturae, as it was 
understood in former times. 

Instances have occurred, in which, a slight gastritis, or a 
pulmonary catarrh have been relieved or cured, by a sponta- 
neous bleeding at the nose, or a copious spontaneous sweat. 
The evacuations in such cases have been called critical and 
nature has had the credit of effecting the cures. Such occur- 
rences do not prove the doctrines, in support of which they 
have been advanced. The evidence would be in point, if it 
could be proved, that the vis medicatrix actually presided in 
the instances mentioned and had an intended recourse to 
those methods of depletion ; and that in consequence of this 
design, she was afterwards enabled to bring about a restora- 

* Sometimes by modern writers called the recuperative power. 



INTRODUCTORY TO THERAPEUTICS. 165 

lion of a healthy condition of the lungs or abdominal viscera. 
The truth is, that the beneficial result is more properly as- 
cribable to some contingency in regard of the schneiderian 
membrane in the one case, subjecting it to an easy rupture 
of its blood-vessels ; and some casualty in relation to the 
condition of the skin, favorable to a ready production of dia- 
phoresis, in the other. In each of the two cases, in a way 
altogether incidental, the necessary depletion had been effec- 
ted, after which, recovery readily followed under the opera- 
tions of the restorative powers of nature. It would be a ri- 
diculous and superstitious credulity, to admit of any other 
view ; unless in a majority of the cases which require deple- 
tion, nature is prepared to avail herself of some sufficient out- 
let for her own relief. 

We admit the existence of a medicatrix naturae neverthe- 
less, but conceive of its operations in a way, very different 
from the foregoing account. Indeed this healing power is 
most distinctly and satisfactorily displayed, in the good 
effects which follow, when the judicious therapeutist shall 
hare made appropriate arrangements for accomplishing his' 
intention. And a proper intention is always formed and ex- 
ecuted, with a constant reference to this power. In all such 
cases, as the two referred to above, a plethora prevails, which 
impedes the regular and healthful performance of the organic 
motions and functions. The disturbance is expressed by 
pain in the stomach and vomiting, in the one case, and by a 
difficult or painful respiration in the other. By a sufficient 
loss of blood from the nose in the one and by a copious flow 
of perspiration in the other, the system is considered to have 
been effectually depleted and set at liberty. The vis medi- 
catrix, then resumed her regular train of motions, and health 
was restored. Without the depletion, a very different state 
of things might have followed. The energies of the system, 
when once concentrated in a train of morbid motions, instead 
of effecting relief by an accidental depletion, in a majority of 



166 INTRODUCTORY TO THERAPEUTICS. 

cases continue an unabated struggle, till they produce a fatal 
cerebral, pulmonary or other congestion. And therefore the 
facts which can be adduced to prove, that in some instances, 
the animal economy, without artificial aid, has seemed to re- 
cover a healthful state of the functions, when they had been 
thrown into disorder, if collated with the many opposite facts 
which prove the indispensable necessity of artificial assis- 
tance : allowing them all that can be properly claimed, can 
prove no more than that disease in a mild form may chance 
to retire spontaneously with or without a crisis. 

But every physician acquainted with the diseases of our 
climate, knows, that by far the greater number of cases 
would persevere, and speedily terminate in death, or become 
chronic and by the laws of sympathy set up complications in 
respect of organs which were not involved in the commence- 
ment, and eventually terminate in suppuration, effusion of 
serum or lymph, or in some other serious or fatal disorder. 
Much skill is required, to prepare the physician to judge with 
certainty, in the commencement of a case, as to the necessity 
of his interference, as well as to the degree and extent of it. 
which may be required. And the great point is. to be able 
with the necessary precision, to adjust the management to 
the circumstances of the case. 

To subdue the violence of inflammatory action ; to release 
organic motion from the oppressive effects of threatened con- 
gestion when plethora abounds : to remove any known 
cause of irritation, when it can be done ; to arouse to a proper 
degree of action any of the secretory organs, when inclined 
to fall into a torpid state ; to protect and preserve the vitality* 
of the surface and extremities of the system when great de- 
bility prevails and afford the necessary support : — these are 
some of the instances of artificial interference to which we 
refer. We mean therefore, that when any or all of these 
things shall have been performed, the physician is still de- 
pendent on an agency, which, when it is performed accord- 



INTRODUCTORY TO THERAPEUTICS, 167 

ing to certain laws petaining to the animal economy, present 
an exhibition of the process and produce the final result, 
which we call recovery; and this power, is the vis medicatrix 
naturae ; for the existence and agency of which, we are 
ready to contend. 

If we contemplate this power with regard to the changes 
produced in the system in any particular instance, say, the 
retirement of plethora, as it is associated with inflammatory 
action, the process of nature will be identically the same as 
to plethora alone, whether she shall have been released from 
the thraldom by blood-letting, catharsis, diaphoresis, or inan- 
ition. So soon as the plethora shall have been removed, the 
inconvenience or threatened injuries, which it had produced, 
will be made to retire, by the agency of the vis medicatrix 
naturae ; that is, by the laws which govern the motions and 
functions of animal life, — now called the recuperative power. 

We have been careful in explaining our views of this im- 
portant power, because every curative intention, if it be phi- 
losophically instituted, will have a proper and constant refer- 
ence to its indispensable agency, and because a suitable ac- 
quaintance with its laws, is one of the surest guides to the- 
rapeutics. We are desirious also to be explicitly understood, 
that in maintaining the existence of the vis medicatrix, we 
are very far from assigning to it that absurd importance ■ 
which once led medical men to pursue the dangerous and in- 
human practice of leaving their patients to languish in pain 
and anxiety, day after day, waiting for a crisis, the infallible 
indication of the course which the vis medicatrix intended to 
take for the removal of the disease. 

Take an explanatory example or two. For one, let us 
turn to a case of pulmonitis. Admitting the presence and 
agency of the vis medicatrix, what is the part she acts, in 
the commencement of the attack. It is an obvious fact, that 
the impetus of the circulation, is dangerously violent, and 
experience has proved, that it must be restrained by blood- 



168 INTRODUCTORY TO THERAPEUTICS, 

letting. The inference then is clear, that in circumstances 
such as those which mark the commencement of this dis- 
ease, nature is not to be trusted without the help of art ; and 
the practice of all modern physicians proves, that the treat- 
ment necessary in such cases, is in direct opposition to the 
tendencies of nature. A still more unequivocal opposition 
to nature's movements, is necessary in treating a case of 
cholera. She loudly reports the necessity of evacuating the 
stomach and bowels. And here, by the way, whilst in one 
important respect she reports the truth, her efforts are so ex- 
travagant, and tend to an issue so adverse, that experience 
has taught us, that the vomiting and purging must be imme- 
diately arrested, or in a few hours the life of the patient will 
be lost. 

Now if nature's indications are to be our guide, without 
restriction, the violent and destructive action which obtains 
in pulmonitis, should be assisted by a copious draught of hot 
toddy ; and the worst instance of cholera should be aided 
with a good dose of tartarized antimony, and followed with 
a sufficient portion of some brisk cathartic ; either of which 
would be absurd. It is after the proper reduction of the mor- 
bid action of nature, by blood-letting, &c, in the one, and 
the suppression of her morbid evacuations by the exhibition 
of the necessary quantity of opium, &c. in the other, that 
we look for the recuperative process which is the work of 
the vis medicatrix naturae. It is true nevertheless, that na- 
ture's pointing is not unfrequently well enough in accordance 
with the most judicious curative indications. In cholera, as 
was noticed above, the evacuations with which the disease 
commences, to a certain extent, are always useful. Being 
morbid, however, they continue and progress with such ra- 
pidity and copiousness, that the balance of excitement is lost. 
In proof of the correctness of this remark, it is a fact, that in 
almost every instance of this alarming affection, after quiet- 
rng the storm by the administration of opium, &c. additional 



INTRODUCTORY TO THERAPEUTICS. 169 

evacuation by the aid of calomel and other appropriate me- 
dicines, not unfrequently by the lancet, is necessary for the 
restoration of good health. Also, in bilious fever, and other 
diseases, which chiefly affect the abdominal viscera, a dis- 
tressing nausea and inclination to vomit are most certainly 
relieved by the operation of an appropriate emetic. And al- 
most all ordinary instances of diarrhoea, and perhaps every 
case of dysentery is best treated with frequently repeated 
doses of some suitable cathartic, say caster oil, modified by 
the addition of laudanum. We have already admitted, that 
bleeding at the nose may chance to occur in cases which 
loudly call for blood-letting, and yet it does not follow, that 
this practice is admissible whenever the nose bleeds. In 
typhus fever, bleeding at the nose may be critical. It often 
is, and much blood may thus be spontaneously lost, with ob- 
vious benefit, in such cases ; and yet at the same time, copi- 
ous blood-letting from the arm, in most, if not all instances 
of this kind, would be fatal to the patient. It is not at all 
wonderful, therefore, that medical philosophers should have 
arrived at that point of elevation from which they look down 
and refuse to be guided, blindfold, by the uncertain direc- 
tions of nature, when she is in the thraldom of diseased ac- 
tion. As properly we might consult an infuriated maniac, 
respecting the propriety of securing him in a straight jacket. 
Aided by a suitable knowledge of anatomy, physiology 
and pathology; observation and experience have raised the- 
rapeutics above the uncertainties which marked the practice 
of the servants of nature. And now, instead of a blind sub- 
jection to the dictates of nosology, which, with anxious ex- 
pectations and doubtful calculations, looked for crises which 
seldom occurred, our therapeutics gives a much more cer- 
tain direction to our practice, and enables us to discover the 
errors, and correct the theory and practice of men, whose 
opinions in their day, were repeated as precious and infallible 



170 INTRODUCTORY TO THERAPEUTICS. 

aphorisms, and carefully recorded and preserved as being 
worthy of universal and perpetual regard. 

The object of the literary labors of physicians of every 
age : the intention of all has been, to acquire an approxima- 
tion to a perfect, or trustworthy method of treating diseases. 
All their labored theories, have heen subjected to the test of 
experience, the faithful pioneer which has been engaged for 
ages in preparing the way for the introduction and establish- 
ment of legitimate therapeutics. She continues cheerfully 
and promptly to perform her part, determined to continue her 
assistance until the healing art shall have been perfected. 
Under her direction and patronage, the profession has laid 
aside as lumber, many of the works which once held con- 
spicuous places in the libraries of physicians, and many others 
are still retained and preserved, rather as monuments of an- 
tiquity, than as valuable practical guides. Every judicious 
practitioner of medicine now knows, that men of great learn- 
ing and little experience, can form opinions, frame them 
into theories, and write specious treatises in their defence. 
But experienced therapeutics comes to the sick bed, and 
proves the worth of doctrines ; it weighs them in the balance 
of clinical exactness, and however specious the arguments of 
their inventors, if deficient in practical truth, it rejects them. 
For after all, any system of theory and practice of physic, to 
be reputable and lasting, must be successful; just as certain- 
ly, as that the greatest physician is he, who makes the most, 
and most distinguished cures. 



INTENTION. 171. 



CHAPTER II. 

AN INQUIRY AS TO WHAT IS TO BE UNDERSTOOD BY THE 
TERM, INTENTION, IN THERAPEUTICS, 

No medical prescription can be judiciously offered , without 
a suitable reference to a well instituted curative indication. 
No curative indication can be philosophically instituted, with- 
out an appropriate reference to the pathology of the case 
under consideration. No truly philosophical view can be 
taken, without a competent knowledge of the physiology of 
the organ, or system of vessels supposed to be the seat of 
disease j and no medicine can be administered with becom- 
ing confidence, until it shall have been proved by sufficient 
experience, to produce the intended effect. It is the busi- 
ness of the therapeutist, to lay his foundation sure in a judi- 
cious intention, and to carry it into effect in a workmanlike 
manner. 

Curative indications have varied at different times, and in 
different countries, as often as the medical theories on which 
they have been based. 

The principal intention of the Humorists, was to correct 
the condition of acrid humors, which they considered to be 
the causes of diseases. This they attempted to accomplish 
by administering remedies which were supposed to concoct, 
or to bring about such a change in those humors, as might fit 
them to be eliminated through one or more of the emuncto- 
ries, which served as sewers for their complete discharge. 

The Mechanicians formed their principal intention with a 
view to the removal of obstructions, and to the restoration 
of a suitable freedom of the vital functions, so as to recover 



172 IXTENTIOX. 



the permeability of the vessels supposed to be obstructed. 
The technical phraseology relating to obstructions, origina- 
ted with this class of physicians. With them, steel was an 
important remedy. It gave additional impetus to the circu- 
lation of the blood, by increasing its momentum: and the 
angular figure of the particles, or atoms of steel, were supposed 
to arm the blood with spiculae, which served to break up 
and fit for removal, the obstructing materials which caused 
diseases. 

The leading intention of the excellent Cullen, who reviv- 
ed and taught the fundamental doctrines of Hoffman, was to 
remove the spasm of the capillary vessels, and give general 
freedom to the circulation: and then regulate the reaction 
with suitable reference to other subsequent intentions, which 
may be considered to have been as numerous as the different 
kinds of diseases which he describes, and the different reme- 
dies which he recommends for their cure. 

Homeopathy, which first prevailed in Germany, is the 
most extraordinary doctrine that has perhaps ever been ad- 
vanced in any age. Its founder is Dr. Hahnemann. It con- 
sists in administering remedies, calculated to produce a series 
of symptoms, precisely similar to those constituting the dis- 
ease. These artificial symptoms, take place of the natural 
ones, which will thereby be driven away : and as these new 
symptoms are the effect of remedies, they will subside as 
soon as the remedies are discontinued. The principles of 
therapeutics in this doctrine, are to be sought for in the rela- 
tion existing between the known effects of remedies on the 
constitution, and the symptoms of the disease, of course there 
can be but three indications — First, opposition. Second, 
heterogeneity. Third, similitude. This last, which is cal- 
led Homeopathic, is the only and most efficacious one. It 
is explained as follows: "When the specific effects of a 
remedy are perfectly similar to the natural disease, they reach 



INTENTION. 



173 



the organs that it has affected. But as two similar diseases. 
cannot exist at the same time, in the same point, and as the 
artificial are more intense than the natural affections, the lat- 
ter give way, and the former are substituted, which also soon 
disappear. Reaction is here salutary, because the Homeo- 
pathic remedy, acting on the organizm exactly like the ex- 
isting disease, this last will react in an opposite direction, 
that is, in favor of health. # " 

The Brunonian system, is distinguished by having chiefly 
insisted on one invariable intention, which was, to overcome 
an asthenic condition of the system ; that is a condition of 
debility, by the employment of stimulants and cordials ; to 
reduce the excitability of the system, by elevating the ex- 
citement, until it is adjusted to an imaginary graduated scale 
of health. 

There are very strong proofs of acute discernment and fer- 
tile genius in this theory; and whatever deficiencies, imper- 
fections, or inexplicable mysteries may be thought to adhere 
to it, Dr. Brown has contributed greatly to the improvement 
of medical science. 

Dr. Rush profitted much by the speculations of Dr. Brown 
and approximated nearer to the truth. He perceived the 
mutual dependence of excitability and excitement ; the re- 
ciprocal elevation and depression of vitality and sensorial in- 
fluence, and he carefully and properly turned the attention of 
the physician, particularly to the protection of the vital or- 
gans ; availing himself of the leading principles of Dr. Brown r 
in view of the general system, and when there was occasion, 
having recourse to such particular agents, as the experience 
of the profession had proved to be necessary for the correc- 
tion of particular organic affections. His leading intention, 
on general principles, therefore, was, to equalize the excite- 
ment, in view of an imaginary scale, adjusted to the tone of 



* Quebec Medical Journal, No. 7, 1827.. 



174 INTENTION. 



the vessels of the organ or structure affected by the disease. 
And then his subsequent intentions, were instituted and car- 
ried into effect, as daily occurrences might direct. A method 
of treatment corresponding to this, will be laid down more 
distinctly in the sequel of this work. 

The distinguished successor of Dr. Rush, has adopted a 
theory which wears an aspect very different from that of his 
predecessor. " Conveniently situated for the purpose, the 
stomach,''' says Dr. Chapman, "is probably the throne of the 
vital principle, from 'which, would seem to emanate an influ- 
ence, that, diffused over the system, preserves the order of 
the parts, and sustains the vigor, tone and well being of the 
animal economy." 

"Languido ventriculo, omnia lauguent"* 

"Assailed however by impressions which it cannot resist, 
this organ, as the centre of association, becomes the seat of 
the first link in the chain of most diseases, and is always the 
chief medium of the operation of remedies in the correction 
of morbid derangement." (Chapman's Therapeutics, p. 95. 
ithed.) 

Whatever superior importance may be hypothetically or 
truly assigned to the stomach, as the centre of associations, 
and however much the elevation of that viscus, may serve 
to divert attention from the fundamental principles of Drs. 
Brown and Rush, we are inclined to think, that the best parts 
of all modern theories, directly or indirectly are derivative 
from Dr. Rush, however unwilling the authors may be to 
make the acknowledgment. 

If we are correctly informed, the professor of the Insti- 
tutes and Practice in the University of Pennsylvania, is much 
more entitled to commendation for his attempts to arrange, 
classify and explain diseases, with a proper reference to the 
organs and structures which are known to be the seats of 

* With a languid stomach, every thing languishes. 



INTENTION. 175 



them, than for his attempts to declare , independence of Dr. 
Rush. And although pains may have been taken to conceal 
the fact, modern teachers of medicine, avowedly nosologists, 
either knowingly or unknowingly, have so completely inter- 
woven into their systems, the great truths taught by oor illus- 
trious countryman, that the discerning student cannot fail to 
see, they all wear his livery. It is true, nosology fitted up 
in dress so respectable, in comparison of what it formerly 
was, may now be considered quite philosophical. 

In this way, the nosologists of Europe and of the United 
States, appear to have extricated the science from mechani- 
cal, chemical and humoral errors which had so long prevail- 
ed. But it is not our purpose to present a system of Thera- 
peutics based on any nosological view of the profession. In- 
dications predicated on such premises, must inevitably mis- 
guide, unless it can be clearly made out, that the groups of 
symptoms which are taken collectively for the description of 
each particular disease, are always the same in similar cases, 
and always succeed each other in the same order. But we 
all know that this is not the case. They vary with the con- 
stitution, temperament, age, &c, of the patient; and each 
of the variations are again liable to other additional modifica- 
tions and changes, in consequence of the remedies which 
may have been used, and of the effects of climates, seasons, 
and modes of living. And there is yet another difficulty, 
which is calculated to add materially to the embarrassment 
of an inexperienced nosological practitioner; which is, at the 
same time, that there are distinguishing phenomena by which 
particular diseases may be known, there are appearances, 
more or less common to all, more or less conspicuous, ac- 
cording to various circumstances. With all these difficul- 
ties in view, it would seem that -'a perfect synoptical ar- 
rangement of diseases is impracticable." And it may be 
safely predicted, that no perfect system of nosology will ever 
be devised. Something useful may be accomplished by those 



176 INTENTION. 



treatises, whose divisions and distinctions have been predi- 
cated upon the natural and obvious divisions of the human 
body ; having their various departments to accord with the 
known differences of organism. But even this device, spe- 
cious as it appears to be, has its accompanying difficulties. 
For at the same time that there are symptoms which are con- 
sidered definitely to point to a particular diseased organ, we 
constantly see additional phenomena supervening ; sympa- 
thetic, incidental and variable, to an infinite degree ; and 
therefore, on the whole, we conclude, that a truly philo- 
sophical system of therapeutics cannot be framed, if it be 
made to conform with any known system of nosology, 
however classical or scientific its doctrines may seem to be. 



THERAPEUTIC INSTRUCTIONS. 177 



CHAPTER IV. 

AN ANNOUNCEMENT OF THE COURSE WHICH WILL BE 

PURSUED IN THE FOLLOWING THERAPEUTIC 

INSTRUCTIONS. 

We propose, first to make ourselves well acquainted with 
general principles and their modifications,, and then endeavor 
to show how this general information will be applicable and 
useful in the investigation and management of particular dis- 
eases. In our observations we shall be guided also, as much 
as possible, by the well known divisions of the human body, 
admitting disease to be specific and particular, whenever it is 
known to demand particular and specific treatment, in conse- 
quence of any definite and well known peculiarities which 
invariably pertain to it when it, fastens on any particular or- 
gan. By this method, it is hoped, we shall be enabled to se- 
cure the necessary discrimination, so as to direct our practice 
against the symptoms which, are the real indices of disease 
and avoid the danger of being, misled by those which are 
merely incidental. We deem it important to be fairly under- 
stood in regard of the discriminations just now referred to, 
and therefore we will add a practical explication or two. 

Without a scientific reference to the anatomy and physi- 
ology of the organs affected in a case, of enteritis, in its com- 
mencement, the time most important for a successful defence 
against its dangers, the patient and even an unwary physi- 
cian, may be led to consider it a mere windy cholic. Heat- 
ing draughts of course may be administered, probably perse- 
veringly repeated, even alcohol in dangerous doses may be 
prescribed, when the only proper indication is very copious 
blood-letting and other suitable evacuations. So also vari- 

m 



178 THERAPEUTIC INSTRUCTIONS. 

ous other inflammatory affections, at the onset, might be con- 
sidered, as nothing more than peculiar expressions of debility. 
and be subjected to treatment equally erroneous. By the 
same kind of misapprehension, hemorrhages produced and 
kept up by an inflammatory action of the blood-vessels in- 
volved in the disease, have been treated with tonics, to the 
destruction of the patients : when appropriate evacuation and 
judicious management might have insured recovery. We 
are aware that the friends of nosology, insist on the practica- 
bility of such general and specific description, as may serve 
with all necessary exactness, to guard against mistake. It 
is nevertheless our settled conviction, that the physician who 
is not prepared to support his nosology, by a mature judg- 
ment in respect to the condition of the affected organ, works 
blindfolded. Admit he may have in full recollection the 
whole series of symptoms which are put down as pathog- 
nomonic, in any given case, still even this will not be suffi- 
cient. The worst diseases do not develope the whole chain 
of symptoms which characterize them, until, in many cases, 
they have progressed too far for the safety of the patient : 
and in all, the disease must at the least have been established 
and its progress have advanced so far, as to render its man- 
agement more difficult and its cure less certain on that ac- 
count. Besides, if we even permit the physician to com- 
mence his operations before the entire character of the dis- 
ease is displayed, this will serve only to increase his embar- 
rassment. It is presumed that the agents to be employed 
will produce important effects. His attention must then be 
turned to appearances perpetually variable and evanescent, 
and he is therefore continually liable to be led astray by the 
agency of his own remedies. He must frequently meet with 
anomalies, bringing him endless embarrassment. Nosolog- 
ical practisers under such circumstances, would be prepared 
to imagine they had found new diseases. Those who have 
made themselves more conspicuous in this way, have gone 



THERAPEUTIC INSTRUCTIONS. 179 



on accumulating their anomalies, until the stock of nosology 
has become an insupportable incumbrance. Unwilling to 
wander through the dark mazes of this region, in support of 
medical information, scientific men have at length deter- 
mined to urge the necessity of a more perfect acquaintance 
with the remote causes of diseases, the circumstances, which 
specify their determination on particular organs, and the ef- 
fects of such determinations ; and instead of the apparently 
classical parade of nosology, to recommend that kind of stu- 
dious attention to anatomy and physiology, which prepares 
the well instructed physician, to trace out the pathology of 
any case which may occur to his observation, whenever 
there is occasion ; and by so doing insure correct diagnosis. 

The unwieldy materials which nosology had imposed 
upon teachers of medicine, as well as the embarrassment 
which it brought to the learner, was felt more particularly 
towards the close of the last century, when men of genius 
and enterprise, began to think of some device which would 
admit of more system and greater simplicity. The ingenu- 
ous work of Dr. Brown of Edinburgh, was an attempt of this 
kind, and served to give an impulse to improvement in our 
profession, which waked up Europe and these United States. 

About the same time, Paul Joseph Barthes de Marmorions, 
who was born at Montpelier in France in the year 1734, and 
died in 1806, made an attempt to simplify the profession. 
He labored to analyse diseases into distinguishing groups of 
symptoms, which he called elements. And since his death 
Charles Louis Dumas, who died about eight years later than 
Barthes, improving on the elementary method of his prede- 
cessor, laid the foundation of what is called in France, the 
doctrines of the school of Montpelier. According to this 
doctrine, a pathological element is a simple disorder, an im- 
aginary assemblage of particular symptoms, which are gene- 
rated simultaneously, almost never separating, produced by 
known causes, having definite crises and periods, requiring a 



180 THERAPEUTIC INSTRUCTIONS. 

special method of cure, having well known post mortem ap- 
pearances, attacking one or another person indiscriminately,, 
or any one organ or tissue of vessels indifferently: possessing 
the power, nevertheless, to affect some one of these in a par- 
ticular manner : and sometimes some one among them exclu- 
sively* An element was not a pathognomonic symptom ; it 
was a disease. But instead of a catalogue of an almost end- 
less number of diseases ; they attempted to conceive of a 
more limited number of the elements of disease. 

They were looking toward the same object, which was the 
great desideratum of Dr. Rush, when he was striving to 
prove that disease is a unit. They seem to have thought, 
that there are elementary morbid affections, which under 
various combinations, take a leading part in the formation of 
all the diseases which can possibly attack the human body. 
And we must admit, that such a system, if fairly made out, 
would have served to simplify the theory and practice of 
physic. The theory of Montpelier however, although it had 
an estimation in France, corresponding to that of Brown in 
Scotland, was more the production of a fertile imagination, 
than of astute clinical observation. A few additional re- 
marks will make this sufficiently clear. 

According to this doctrine, we will suppose plethora to be 
an element. Plethora however, is more properly a predispo- 
sition to disease, than any thing else. There is however an 
approximation to philosophy in the specification of this par- 
ticular, as an element in the formation of disease. So also 
pain is an element, and pyrexia, and debility, and spasm, &c. 
Now our object is to show the effect, which such an elemen- 
tary scheme was intended to have on their therapeutics. The 
occurrence of plethora being ascertained, the proper intention 
is obvious at once. Too great fullness must indicate the 
necessity of evacuation. Pain, would indicate the necessity 
of administering an anodyne ; spasm of some appropriate 
antispasmodic ; pyrexia of antiphlogistics, and debility of 



THERAPEUTIC INSTRUCTIONS. 18l 

tonics. All this, at first view, looks very specious j — patho- 
logical elements directly indicating the most appropriate rem- 
edies. But the judicious physician feels 'it necessary to 
know, what circumstances may have concurred in producing 
the plethora ; what the cause of pain ; in what organ it is 
seated ; in what manner the anodyne is intended to act. Is 
disorganization threatened which might make the anodyne 
pernicious ? In a case of spasm, an antispasmodic is to be 
administered. The phylosophical physician inquires, what 
cause has produced, what irritation maintains the spasm ? By 
what kind of agency is the antispasmodic remedy expected 
to produce relief ? The elementary system appears to have 
been deficient in these essential points, quite unprepared to 
furnish satisfactory answers to these important inquiries. 
And yet there appears to have been so glaring a demand for 
such answers, it is rather surprising that something more sat- 
isfactory in relation to this deficiency, was not added. Again 3 
spasm indicated the use of antispasmodics ; if spasm be con- 
sidered as an element, alas ! we find it in tetamus, epilepsy, 
hydrophobia, hypochondriasis, cholic, and many other dis- 
eases. Then, valerian camphor, musk, ammonia, hoffman 
anodyne, hyosciamus and opium, would be common reme- 
dies for all these diseases. Debility, if considered an ele- 
ment, in like manner attends epidemic catarrh, influenza, 
bilious fever, typhus and typhoid fever, pneumonia ty- 
phoides, scarlatina, bronchitis, &c. Of course all these in 
common, would require stimulants, tonics and cordials : 
since, if the elements are to be our guides, whenever any of 
them appear, our indications must of course be, to employ 
their proper antidotes. The absurdity of which is sufficiently 
obvious. Dr. Brown's system partook too much of this de- 
fect. We presume, however, that the school of Montpelier 
intended their elements to be partial guides only; and under 
the correction of experience, they no doubt had their use. 
Even Darwin's theory of irritation, sensation, volition and 



182 THERAPEUTIC INSTRUCTIONS. 

association, is better than none. After this preparatory di- 
gression, we return more directly to our subject. 

Curative indications can have no more solid foundation, 
than an extensive and well digested knowledge of the cau- 
ses, seats and nature of diseases ; which implies a knowledge 
of the structures and functions of the organs or tissues which 
are diseased ; and the nature and extent of the injury which 
they may have sustained. When we shall have made the 
necessary investigations in view of these particulars, we make 
up our judgment as to the character of the disease and have 
recourse to such medicines, as we may have learned from our 
own experience or that of others, to be effectual in similar 
cases. If the intention shall have been correctly appointed, 
and executed with skill and decision, the disease will retire ; 
or its continuance will justify the conclusion, that it is incu- 
rable by the means so appointed. In some instances, how- 
ever, when everything pertaining to the curative operations 
shall have been properly planned and executed, and when a 
satisfactory yielding of the morbid appearances shall have 
proved the correctness of the whole, still the effect is net 
complete. In such instances, the obstinacy of the symptoms 
may be considered to be consequent on the existence of an 
irritation, which has become in some sort independent of the 
original affection, and which requires a modification in the 
subsequent prescriptions, and a longer continuance than 
usual, of the management which has been found appropriate 
and more speedily effectual in ordinary similar cases. 

If more than one organ appear to be affected at the same 
time, or if the disease extend its influence to parts remote 
from the organ which was primarily affected, the intention 
of cure is sometimes first directed towards one organ, some- 
times towards another, in succession ; sometimes it has a pro- 
per reference to all at once, including within its scope the 
principal injury as well as any complication, whether they 
be sympathetic or secondary associations or consequences 



THERAPEUTIC INSTRUCTIONS. 183 

which may accompany or follow it. Still, in each and all cases, 
a regard to the seat and nature of the disease is to regulate 
our therapeutic indications. And this is equally true, whe- 
ther the patient be old or young, male or female, robust or 
delicate. In all cases the fundamental principles are the 
same ; but different circumstances may require considerable 
modification in the details of the practice. Different remote 
causes, referrable to different climate, constitutional tempera- 
ment, modes of living, intemperance, and sometimes sudden 
changes of residence, or of articles of clothing, or diet, each 
may require some modification of treatment ; but any such 
variety will be a secondary consideration. It may make it 
necessary to introduce one article in place of another ; or 
some one preparation of an important agent, rather than an- 
other ; or it may require the application of the remedy or its 
introduction into the system, by a peculiarity of manner f 
suited to the case ; still the leading intention will be the 
same. 

An inflammatory affection, for instance, must be treated 
with evacuation and other corresponding remedies. This 
will be the general plan, whether the case under deliberation 
be violent or mild, recent or chronic ; whether the patient be 
vigorous or feeble in constitution ; old or young; male or 
female; an ad alt or an infant. The kind of depletion, or 
the extent of it, as well as the concomitant management, 
will be different in each. So far as general principles are 
concerned, the intention is the same, the practical details 
only are subject to variation. 

A physician practising in conformity to these views, has 
incessant occasion to refer to physiology and pathology, and 
his discriminations will be clear, positive, and disengaged 
from the conjectures which are raised under the arbitrary 
empirical dictates of nosology. He will be prepared to judge 
of the modus operandi, as well as the value of the agents 
Ue may employ ; moreover he will be in possession of the 



i84 THERAPEUTIC INSTRUCTIONS. 

only proper means of correcting his own theory and practice. 
It is true, nosology may assume the appearance of great pre- 
cision, and with the display of its modern classification 
may be imposed on beginners as the only classical and sys- 
temmatic view of the profession. Yet, after all this parade, 
the art of healing, in that dress, is miserably imperfect, and 
therapeutic indications made under its auspices, must be con- 
jectural. The physician who refuses to follow such a blind 
guide, and is directed by his own knowledge of physiology 
and pathology, is certain in his views, as to the seats of dis- 
eases. Well acquainted with the phenomena which attend 
on the healthy functions of the organs, he is at no loss to 
judge of the pathology of the case. It follows of course, 
that when he administers his remedies, he is prepared to es- 
timate their effects, and judge whether they satisfactorily cor- 
respond with the therapeutic indication for which they were 
prescribed, or whether they approximate towards its accom- 
plishment ; and how far they fall short of it. In a word, he 
can decide with accuracy as to the propriety of pushing his 
intention, or retiring it ; without unnecessary hazard or loss 
of time. 



AGE, TEMPERAMENT, ETC. 185 



CHAPTER V. 

THERAPEUTICS CONTINUED— CONSIDERATIONS IN RE- 
SPECT OF AGE, TEMPERAMENT, &c. 

Having presented a sketch of some of the principal theo- 
ries which in their day were in repute, in order to show what 
is meant by a therapeutic intention, let us attend to some 
particular circumstances, which will claim consideration, 
when there may be occasion to perform a work of so much 
importance. These have respect to age, temperament, sex, 
professional pursuit, habits of living, strength and debility ; 
to the causes of diseases, their seats, the degree of their inten- 
sity, and the periods of their duration. 

In youth, the nervous system is more acutely susceptible 
of irritation, and more readily takes on sympathetic action. 
Irritation, of course in less time by continuity, becomes com- 
plex and difficult of investigation ; morbid action more speed- 
ily destroys the organ first affected, and extends its influ- 
ence to the sensorium and to the arachnoid membrane. 
The stomach and lesser intestines of young people too, be- 
ing more active in performing the functions of assimilation 
for purposes of growth, &c, are subjected to a more frequent 
and laborious service j those organs are, therefore, more fre- 
quently affected with congestion and inflammation. On these 
accounts, in all cases of sick children, the blood making or- 
gans ought to claim special attention. Irritations of the ab- 
dominal viscera are frequently very alarming ; and if neglect- 
ed, rapidly become dangerous. The secretions thrown off 
by the mucous surfaces, when in a state of irritation, have a 
tendency speedily to become inspissated, the exhalents are 



186 AGE, TEMPERAMENT, ETC. 

embarrassed, the secretions diminished, till it would seem 
that the effect contributes as largely as the disease itself, to the 
work of destruction. 

Croup, furnishes very prominent, and most frequently fa- 
tal examples of this peculiarity of affection. In children the 
villous coat of the intestines is more liable to be disorganized, 
passing into a gelatinous state ; hence the speedy occurrence 
of a cadaverous foetor in cholera infantum. 

From the whole we infer, and practical observation justi- 
fies the inference, that infants, children, and youthful pa- 
tients, require a decisive practice, corresponding to the fore- 
going remarks. According to physiological and medical cal- 
culation, the energies of infants not only equal, but exceed 
those of adults. Vitality is greater in early life, than at la- 
ter periods ; all the vascular actions, whether healthy or 
morbid, are performed with greater activity. Inflammation, 
for example, is more frequent than in adults ; and it runs its 
course more rapidly, through its different stages, to disorgan- 
ization and death. Greater promptitude and activity of 
treatment are necessary, and very decisive blood-letting when 
called for by the circumstances of the case. When blood- 
letting is required, it may commonly be considered to be im- 
periously necessary, and ought to be performed without at- 
tempting to substitute other evacuations. A speedy and de- 
cisive discharge of the foeculent matter from the bowels is also 
required in such cases;* and in almost all others which call 
for medical aid. And when this kind of prompt and effec- 
tual treatment is withholden, overwhelming irritations or fa- 
tal congestions very often destroy the patient. It should be 
particularly remembered, that when such decisive practice is 
necessary, rigid abstinence from nutritious diet ought to be in- 
sisted on. In children, it will be found on careful examina- 

* When infants and young children sicken, especially in warm weather, all 
drastic medicines are to be avoided or cautiously used. The mucous lining 
of their intestines can be ruined by one dose. 



AGE, TEMPERAMENT, ETC. 187 

tion, in many cases, when they are seriously indisposed, that 
the abdomen is enlarged, proving, either that the intestines 
are too much distended, or that the viscera are swollen, or in 
the condition called hypertrophy. If the enlargement be 
consequent on fulness of the vessels, or a flatus, it will be 
known by making pressure with the hand • and in such a 
case, with or without blood-letting, sufficient catharsis will 
not fail to reduce the abdomen to its proper size and condi- 
tion, and remove at the same time, all the morbid phenome- 
na which were produced by the existing fulness of the portal 
vessels. If the enlargement of the abdomen resist the pres- 
sure of the hand, and especially if the liver, or any other vis- 
cus be discoverable by reason of its unnatural solidity, then, 
although cathartic medicines are imperiously necessary, still 
caution and time will be required in conducting the treat- 
ment; moderate repetition, rather than hasty decision, is to 
be pursued in such cases, paying a proper attention to the 
strength of the patient, until the indication shall have been 
accomplished. Alterative agents, together with a suitable 
repetition of cathartics ; light and sparing diet ; supporting 
the action of the stomach, liver, &c, with pleasant and suit- 
able diluents. This is a summary view of the practice ne- 
cessary in all such neglected cases. We will add only, that 
gelatinous syrups, and saccharine mucilages, which in adults 
are ordinarily consistent with dietetic views, are to be in- 
terdicted in the treatment of children, as such asticles are 
too nutritious, to be consistent with a true therapeutic in_ 
dication. 

The ordinary doctrines in Great Britain, Prance, indeed of 
most countries of the world, have been, that children, be- 
cause of the delicacy and susceptibility of their organs, ought 
to be treated with the mildest remedies, or if we find it ne- 
cessary to use active articles, to administer the smallest do- 
ses. The experience of the most judicious physicians in our 
country, has proved that our practice here, must be very dif- 



18S AGE. TEMPERAMENT. ETC. 

ferent. in all cases of a similar character. It is true, never- 
theless, that after a proper decision in acute cases, and also 
after the necessary impression shall hare been made in those 
that are mild, much may be accomplished by management, 
and the continued use of -appropriate and mild remedies. 
The tendencies of organic life to repair any injuries which 
may have been inflicted : the recuperative powers are so great 
in infancy and youth, that recovery is sometimes possible, 
when appearances at first are very unpromising ; and there 
are chronic affections, in which decision would be impro- 
per : such are best treated with the gentler articles, and 
suitable management. Some of these are scrofula, rachi- 
tites, &c. 

In the decline of life, all the vital functions are performed 
with less vigor, of course our therapeutics must be modified 
by considerations in view of that fact. Old men, as well as 
young, are liable to exposure and accident, and therefore 
likewise to injury, inflammation and fever in various forms. 
In all such cases, after duly considering that nature, tired 
with years, is slow in recovering strength ; sparing in her 
elaborate productions, requiring time at every step : our treat- 
ment is conducted by the same general principles, in age. in 
middle life and in youth. Old age is. however liable to dis- 
eases peculiar to itself: diseases which seem to be, in a great 
measure, consequent on the wear and tear of life. These 
affections require the introduction of other considerations. 
It would seem that organism and organization long continu- 
ed, and especially if subjected to any considerable extra ex- 
ertion by intemperance, must sooner or later assume the con- 
dition of irritation. Irritation coming under the laws of as- 
sociation, will continue to spread itself, till the tissues in near 
affinity with the fretted organ, are brought into the train of 
morbid action. So the genito-urinary system, very often is 
made to exemplify this statement ; when men advanced in 
years, are subjected to diseases which embitter all the recol- 



AGE, TEMPERAMENT, ETC. 



189 



lections of early life, in which they too much delighted. 
Dysuria, with its painful and fruitless efforts ; dysuria muco- 
sa, and other affections of the neck of the bladder ; schirrus 
enlargement of the prostate gland and of the testicles; vari- 
cose enlargement of the blood-vessels of the testes, especial- 
ly the veins ; schirrus affections of the stomach and duo de- 
num ; schirrus and other affections of the liver ; diarrhoea ; 
catarrhal affections and tussis senilis ;- hypertrophy and en- 
largement of the heart ; dypepsia ; asthma j angina pectoris. 
In addition to these, the serous and mucous tissues become 
fibrous and cartilaginous, and the sensorium itself gives signs 
of fatigue by paralysis, &e. It will be obvious to the most 
ordinary judgment, that a palliative plan of treatment is all 
that can be instituted prudently in such cases, which,, from 
the very nature of things are incurable. During the continu- 
ance of youthful vigor, organs and functions though often 
excited to excessive action, may continue in a condition ap- 
proximating to their natural and healthful state. But as age 
advances, preternatural enlargements, irritations and indura- 
tions of parts often begin to prevail, and when such 
a state of things is consequent on excess in eating, drinking, 
&c, it is likely to continue on with increasing rapidity, un- 
til eventually, the organism becomes entirely disordered, 
and the proper functions cease to be performed. It fol- 
lows, that moderation in the pleasures and toils of life, 
serve most effectually to prevent the distressing diseases of 
old age.* 

*A note by my much esteemed, now deceased, friend, Dr. Peter Snyder, 
late of the city of Baltimore. 

It is incalculable what good would result to mankind, if they could be im- 
pressed with a sense of the true effects of excessive organic action, habitu- 
ally repeated. Reflecting people, if their observation on their own experi- 
ence, were intelligibly directed by their sklilful friend, would generally be 
led into conviction of the inevitable debility and suqsequent disorder, that 
any organ long overtasked would fall into. If physicians were more tho- 
roughly instructed in these physiological and pathological truths, they would 
address themselves to the people with a force of authority, by which the ig- 
norant, yet honest mind,, would feel, and by which, it would be quieted*. 



190 AGE, TEMPERAMENT, ETC. 

We defer any additional remarks on the subject of age, and 
proceed to some considerations which have respect to temper- 
ament. Here we propose three general classifications ; each 
of which we suppose to depend on a peculiarity in the struc- 
ture of its respective tissues of vessels. The first, on that of 
the blood vessels ; the second, on that of the nerves ; and the 
third on that of the lymphatic system. In making these 
three general divisions, we have in view some of those evi- 
dences which appear satisfactorily to prove, that certain laws 
peculiar to each of them, do maintain a predominance over 
the remaining two, and indeed over the whole system. We 
also have in view, the fact, that the peculiarities which con- 
stitute organic temperaments, are not less evident, than those 
on which we rest these general divisions. After we shall 
have disposed of these, we may find it convenient to pay a 
suitable attention to the subject of organic temperaments. 

There are many persons of both sexes, whose blood-vessels 
are very conspicuous, in all their sensible appearances. Their 
arteries, to the touch of the finger, express a firm and effec- 
tual consent with the systole and dyastole of the heart. The 
condition of the circulation affords proof of a firm structure, 
and ample calibre, in every arterial tube; and when in or- 
dinary health, the veins of such individuals stand out in bold 
relief. Of such we are ready to say, they have excellent 
systems of blood-vessels. And this is true in view of two 
important considerations — First, if a person of this description 
should need blood-letting, it may be performed, commonly, 
with fearless decision ; and if required, it may be repeated 
again and again; and under ordinary circumstances, it will be 
followed by a speedy reaction, that is, the return of a free and 
active circulation, which follows the weakness consequent 
upon blood-letting. We use the same word in those cases, 
where conspicuous signs of debility give place to an improv- 
ed circulation. Again, should blood-letting have been omit- 
ted in such a case, at any time when it would have been 



AGE, TEMPERAMENT, ETC. 191 

particularly useful in the commencement of an attack, the 
firmness of the vessels will be found capable of sustain- 
ing the stress, a longer time without running into a 
state of fatal congestion ; which often occurs to persons 
of a different temperament. Besides, persons of the san- 
guineus temperament, according to this view of it, may 
often be relieved, though late, by blood-letting cautious- 
ly and frequently repeated, apparently in circumstances, 
in which the same practice, however carefully perform- 
ed on a patient of a different temperament, would be 
improper and produce a state of things the most occult 
and dangerous, terminating after metastasis or other em- 
barrassing phenomena, in a way to make it very suspi- 
cious, whether the prescribing physician were not ignorant 
of the true nature of the case. Moreover, it is an important 
fact, that persons of this temperament, when attacked with 
an inflammatory affection, ordinarily present symptoms which 
happily lead to a suitable defence, without delay. The ex- 
citement in such cases is usually intense and vascular, the 
pulse full and incompressible • the respiration indicative of 
the degree of stress imposed on the pulmonary vessels ; ap- 
pearances proclaiming the necessity of blood-letting and other 
evacuations. We will add only, that among those classes of 
mankind, who are engaged in active and laborious employ- 
ments from their youth up, we find the most distinct and 
the greatest number of instances of this kind of temperament. 
And of course, as the best heritage is such a stability of con- 
stitution and firmness of texture of the blood-vessels, as those 
persons are heirs to, they must be ranked among the most 
fortunate, who are blessed with an education and lot of this 
sort. 

In treating of the sanguineous temperament we were able 
to invite attention to plain facts, visible and tangible to ordi- 
nary observation. We regret that it is not in our power, to 
be equally clear and intelligible on the subject of nervous 



192 AGE, TEMPERAMENT, ETC. 



temperament. This important tissue of vessels, which bears 
an imperious sway over all the motions and functions of the 
human body, is subject to medical observation, only through 
the phenomena by which their influence is expressed. Per- 
sons of this kind of temperament, are commonly as remarka- 
ble for the delicate appearance of their skins and almost en- 
tire concealment of their blood-vessels, as those of the san- 
guineous are for the conspicuous enlargement and display of 
theirs. They are generally such, as have been too tenderly 
brought up ; frequently, they have a full and fleshy appear- 
ance, but are ill able to sustain fatigue : and the greatest 
number of them, are found to be of the softer sex. Persons 
of this description, when seriously attacked with fever, ex- 
hibit phenomena so various and perplexing, as to make it ex- 
tremely difficult for a young and inexperienced physician, to 
avoid mistake. Whilst the ordinary symptoms attendant on 
fever are scarcely discernible, the sympathetic appearances 
are intense and alarming, to a degree far transcending a just 
report of the existing irritation. And very often, at the same 
time that violent pain, spasms or even convulsions, occur in 
quick succession, there is no obvious evidence of inflamma- 
tory action, or of considerable organic injury. In such cases, 
the morbid influence by which the disease is kept up, is con- 
fined to the nervous system, whilst the blood-vessels escape 
irritation. The degree and manner of disturbance of the 
blood-vessels are expressed by frequency and irregularity of 
the pulse, whilst the circulation of the blood is not percepti- 
bly accelerated. The appearances, generally, are such as 
indicate debility. And this makes the principal difficulty. 
The debility is indirect, and the use of wine or alcohol will 
serve only to increase the disease. It is true, excitement of 
the blood-vessels languishes, as if partially forsaken by the 
vital powers of th& system, whilst there is a morbid determi- 
nation of those powers on the nervous tissues. On this ac- 
count, although wine and alcohol are pernicious, stimulants 



etc. 193: 

of a certain kind are found by experience to be necessary: 
such as first the application, externally, of rubific agents, 
sinapisms, fyc. — internally, of an infusion of cloves or capsi- 
cum; Hoffman's anodyne ; Russian castor; assafoetida ; lo- 
belia inflata; oil of turpentine, &c. These articles, judi- 
ciously administered, have a tendency to correct the morbid 
aberration of the sensorial influence, and of course, to relieve 
the nerves by rousing the blood-vessels and bringing forward, 
a fair expression of the state of the system. When this shall 
have been accomplished, it is usually found, that small or 
topical blood-lettings, frequently repeated, gentle aperients, 
with or without the addition of a suitable portion of calomel, 
rubific frictions, blisters, &c. constitute the kind of practice 
which is proper in such cases. And to guard the state of 
convalescence, the patient should be advised to repose, sub- 
stituting frequent friction for exercise, till strength is 
recovered; afterwards, cold bathing, agreeable and mu- 
cilaginous drinks, a tranquil state of mind ; entertaining 
company and conversation ; passive exercise, as riding in a 
carriage ; and at length moderate labor. 

By the lymphatic temperament, we mean that peculiar 
texture of the system, which renders it more liable than oth- 
ers, to such morbid affections as are particularly referable to 
the lymphatic system. Persons of this description are more 
nearly assimilated to those of the nervous temperament. In 
each of these, the blood-vessels are less conspicuous, than in 
those of the sanguineous. Those of the lymphatic system, 
display their blood-vessels least of all. Both are inclined to 
be fleshy, but the latter most readily become fat. If affected 
with fever, neither of the two will exhibit a bold arterial ac- 
tion like the sanguineous system, but the lymphatic patients- 
exhibit a more distinct expression of strong arterial action, 
and admit of more decisive blood-letting than the nervous. 
Spasm and other appearances indicative of a prevailing de- 
termination of the sensorial influence upon the muscles, dj?> 
13 



194 AGE, TEMPERAMENT, ETC. 

not attend ; and this constitutes the most conspicuous differ- 
ence in respect to these two temperaments. There is, how- 
ever, another kind of discrimination, which may be made 
with great certainty. At the same time that persons of a 
sanguineous temperament, present a conspicuous display of 
their blood-vessels, their skin is freely expanded over the 
whole body, and can be lifted with the thumb and finger, 
with considerable ease, not being bound down to the cellular 
substance. But it is not so with persons of a lymphatic tem- 
perament. If an attempt be made to raise the skin in these, 
after the manner just described, it will be found to cleave 
fast to the cellular substance, and to be fitted to such a degree 
of tightness, as to make it difficult and even painful to grasp 
or raise it up at all. In persons of this temperament, it 
would seem, that local irritations do not so constantly make 
that kind of impression on the general system, which makes 
up general sensation, and any morbid affection without exci- 
ting much attention passes into a chronic state ; the condi- 
tion of the organs is changed, morbid secretions are elabora- 
ted ; new and morbid growth of parts is produced ; which 
imperceptibly go on involving the lymphatics in their vicin- 
ity; and in many instances the unhealthy condition is exten- 
ded too far for recovery, before the patient is apprised of any 
danger ; as is the case, for instance, in suppurative erysipelas. 
So much for these prominent characters of general tempera- 
ments. 

There are temperaments also, which we distinguish with 
a reference to some particular viscus, each of which, 
from some peculiar constitutional or accidental condition 
of its texture, or from some sort of peculiar irritability, 
is first or most seriously affected by any attack of disease 
which befals persons of this description. Under this 
view of the subject, we have persons of a phrenitic tempera- 
ment, others of a pulmonic temperament, others of a gas- 
tritic, and still others of a gastro-enteritic temperament ; an 



195 

hepatic and so on in reference to any of the organs, which, 
when diseased can so enlist the sympathies of the system, as 
to produce general pyrexia. 

We intend to be understood, that at the same time when 
one of the three general temperaments prevails, there may 
also exist a particular or organic temperament, and that the 
particular affection will be more or less modified by the gene- 
ral temperament. By way of illustration, a patient of a san- 
guineous temperament, may be constitutionally or acciden- 
tally liable to attacks of pulmonitis, as also may be persons of 
either of the remaining two. Of the three general tempera- 
ments, a patient of the sanguineous, will be most easily man- 
ageable, and the disease will be less likely to be followed by 
an ill condition of the lungs. The lymphatic patient will 
be managed with greater difficulty, and there will be greater 
cause to fear that the disease may produce that state of the 
lung which ends in phthisis pulmonalis. Persons of this 
temperament, when affected by inflammation of the lungs 
are liable to effusions, and in the absence of inflamma- 
tory symptoms, to that particular form of pectoral disease, 
which is called pleurodynia. Persons of either of the 
three temperaments, may be liable to gastritis; the case is 
most manageable and the prospect of recovery best, in the 
sanguineous. Persons of either of the three, may be intem- 
perate in eating and drinking, and thus subject themselves to 
a predisposition to hepatitis. The prospect of the lymphatic 
patient, in such a case, will be the worst ; that of the san- 
guineous, best. If the liver or any other important viscus be 
seriously affected in a person of a lymphatic temperament, 
an extensive catenation of the lymphatic tissues, including 
the whole glandular system, will be implicated in a manner 
corresponding to the lymphatic association of those parts of 
the system. And very often, the parts which are thus sym- 
pathetically involved, are in the end as seriously affected by 
the morbid action, are as much distressed with pain and dis- 



196 AGE, TEMPERAMENT, ETC. 

organized by disease, as the viscus, which was the original 
seat of the complaint. 

The general influence of the nervous temperament is like- 
wise conspicuous. Persons under its dominion, will often 
exhibit such entire submission, that at the same time that an 
alarming organic disease is committing its ravages on some 
important structure, or viscus, the nervous symptoms are so 
strong and predominant, that the true cause and seat of the 
disease which is threatening the destruction of the patient, 
are with difficulty detected ; too often they have remained 
undiscovered, till recovery was impossible. We have known 
bilious fever consequent on great congestion of the liver and 
portal vessels, to commence its attack in the garb of hysteria. 
Globus hystericus being the chief inconvenience felt by the 
patient for the first entire paroxysm ; and belching, borbo- 
rygmi, dysuria, &c. were the only prominent symptoms, till 
moderate blood-lettings and frequently repeated cathartics, 
served to disclose the true character of the disease. Persons 
of the nervous temperament are very often the subjects of the 
most serious chronic affections of the liver, spleen, and mes- 
entery, which are secretly undermining life. The true con- 
dition of things is not suspected, because the patient com- 
plains of low spirits, head-ache, habitual cholic and constipa- 
tion. And so also of many other similar affections, such as 
dyspepsia and subacute gastro-enteritis. It is important that 
we should diligently acquaint ourselves with these diversities 
of temperaments, and, ever intent on the detection of the 
diseased organs, take care that none of these fallacious ap- 
pearances, none of these sympathies shall lead us astray. 
Indeed, this should be a constant practice in every case of 
fever. And in all cases attended with pain in the head, tho- 
rax, or abdomen, we ought to make diligent inquiry into the 
state of the important viscera ; taking great pains not to con- 
found appearances that are merely sympathetic, with the pa- 
thognomonic symptoms of the disease. In the mean time. 



197 

we may profit by our acquaintance with the sympathetic 
relations, which obtain in various morbid affections, as they 
serve to prove, that there may be excess of action threatening 
destruction to one organ, whilst there is deficiency of action 
in another ; making it important that we should find ways 
and means, to divide, divert, or extinguish the irritation ex- 
isting in any case. That there may be general debility, at 
the same time that a morbid excitement is threatening de- 
struction to some particular organ ; of course calling for the 
employment of some measure, which may divert the excess 
of action from the suffering organ and diffuse it throughout 
the general system. With intention to produce such changes, 
we associate with the use of internal general agents, the ex- 
ternal application of issues, antimonial plasters and epispas- 
tics ; all of which are repeated or perpetuated, according to 
circumstances. 

The persons of women are more susceptible of injury, their 
nerves more readily take on irritation, than those of the 
males. They are liable to diseases peculiar to the sex, as 
well as those common to both. Moreover, their ordinary 
diseases are subject to modification through the influence of 
their peculiarities. The uterus subjects them through a 
great part of life, to a periodical inconvenience in the secre- 
tion and discharge of the catamenias. This is liable to be 
checked or suspended ; and when either of these occurrences 
takes place, it requires the most careful attention. Indeed, 
so great is the influence which this secretion has on the fe- 
male system, that it may be considered to participate, more 
or less, in producing all the extraordinary modifications of 
the diseases of women. With a majority of the sex, the 
uterus may be considered the central point to which may be 
referred, nearly all the sympathetic affections which obtain 
from the time of puberty, till the menstrual secretion disap- 
pears. So long as this function is preserved in natural con- 
dition • animation, activity and health abound* ill health 



198 AGEy TEMPERAMENT, ETC. 

and a long train of inconveniences soon follow its suspension. 
If a woman, when in this condition of suspended catamenia, 
should have an attack of fever, or be subjected to an inflam- 
mation of any important organ, her disease in either case,will 
become more difficult to manage, on that account. Inflam- 
mation or congestion will make more extensive and speedy 
progress \ and if there should be appearances like catamenia, 
at any time whilst the disease is raging, the discharge, on 
examination, will commonly prove to be a mere hemorrhage, 
showing that the uterus, in such cases, is liable to be greatly 
excited. 

We have offered these few remarks, with a view to incul- 
cate the necessity of a strict attention to this important and 
interesting peculiarity of the fair sex ; for when any other 
irritation may have been instituted for this discharge, it is 
highly necessary that we should be aware of it in time. 
Intelligent females universally expect a due degree of atten- 
tion to a point, in which they all know their sex is so deeply 
concerned ; and therefore an oversight in regard of it, would 
inevitably leave an impression unfavorable to the reputation 
of the profession. 

If a woman, after some imprudent exposure, by which the 
catamenia shall have been suspended, should be seized with 
a violent affection of the head, lungs, or stomach, calling for 
a copious depletion, it sometimes happens, that a large blood- 
letting, not only relieves her of her painful affection, of 
whatever kind it may be, but it will serve also to bring about 
a complete restoration of the suspended secretion. If, how- 
ever, this should not follow, it is necessary to add a sufficient 
repetition of appropriate cathartic doses, aiding them with 
suitable management, until the ultimate intention shall have 
been accomplished. If the suspension be the discoverable 
cause of complaint, then regard must be had to the general 
condition of the system, particularly to the great blood- 
making organs. If the suspension be the effect of general 



AGE j TEMPERAMENT, ETC. 19§ 

debility, it is vain to look for its restoration, until a better 
state of general health shall be established. If it be conse- 
quent on some organic disease, the affected organ must be 
rectified, and then the inconvenience, which is the effect of 
it, will retire of course. 

There are also peculiarities incident to women, because of 
the vastly important circumstances which attend parturition. 
One of these has respect to the condition of the abdominal 
viscera, when they shall have been made weak by compres- 
sion, and injected in consequence of the retirement of that 
compression. When this occurs, it requires to be treated 
after the manner of enteritis. Another has regard to the 
violence of the throes of the uterus, and the consequent rude 
distension or contusion of the vagina and os externum. In- 
jury in this way, followed by inflammatory symptoms, will 
require a treatment like any other inflammatory affection. 

There is a third which has respect to lactation. If lacta- 
tion only be implicated, the milk fever is the concern o4K °* 
a day, and any accidental interruption of the function of the 
mamma, will often produce great disturbance for a day, but 
it usually retires on a very moderate degree at evacuation 
and suitable attention. This inconvenience $ vulgarly called 
the weed. 



200 STRENGTH AND DEBILITY, ETC 



CHAPTER VI. 

THERAPEUTICS— STRENGTH AND DEBILITY, TRADES, PRO- 
FESSIONS, HABITS, &c. 

When we speak of strength, in relation to the. practice of 
physic, we do not intend merely a healthy and vigorous con- 
dition of the animal functions, in which we perform with 
ease and comfort all ordinary exertions : we have respect 
more particularly to the physiological and pathological cal- 
culations of strength ; to the expression given of it in the or- 
gan* action itself, in the motion of the arterial system, and 
in the support it affords to the vital functions. And when 
we speak of weakness, we do not intend merely an inability 
to run or labor, but also that feebleness in the motion 
and action of t ae organs essential to life, which is sometimes 
experienced in the commencement of fever, as also, that spe- 
cies of debility, which always occurs towards the close of a 
very violent or long protracted disease. The two states of 
the system, strength and weakness, are correlative : the esti- 
mate which we make of them, is always comparative : and 
our estimate will be more or less certain or useful, according 
to the correctness of our standard of judgment, and the accu- 
racy with which we learn to apply it. To acquire a sound 
judgment in this particular, is one of the great points of skill 
in our profession ; and an approximation to perfection in it. 
is within the reach of a well directed experience. 

There is a difficulty, nevertheless, in making the attain- 
ment ; inasmuch as the estimate must be accommodated to 
all the variations of circumstances consequent on difference 



201 

of climate, education, manner of living, and temperament. 
The physician should therefore begin to pay attention to 
this subject, at the commencement of his studies ; and it is 
proper, that he should be informed at the threshold of his 
profession, that books, even when aided by the best instruc- 
tion, will not afford the kind of information, which is par- 
ticularly necessary in respect to this subject. It must be the 
result of his own observation. He must pay attention to a 
sufficient number of instances of the several distinctions 
above specified, and make himself acquainted with the pulse 
and general appearances, which mark the healthy and vigo- 
rous state of each of them. And as opportunity may serve, 
he must in like manner make himself acquainted with the 
pulse and other circumstances, which attend on each, when 
in a state of debility. Having drawn the two lines of dis- 
tinction, his experience will soon enable him to conceive of 
all the intermediate grades that can be usefully distinguished, 
from the highest point of inflammatory action, down to the 
degree of debility which ushers in death ; a standard of judg- 
ment, which once regularly formed, will admit of a satisfac- 
tory application in all cases. Therefore, as early as possible, 
the student should cary out the investigation in reference to 
some one particular classification of persons, as often as it 
may be convenient, until his judgment in regard of that one, 
shall have been matured. Then, one classification of esti- 
mates so matured, will afford much facility in the subsequent 
prosecution of similar investigations. At length, having ac- 
quired a general view of the subject, he will be prepared 
promptly to perceive the due degree of strength, or debility, 
which may obtain in any given case, and to prescribe with 
judgment. Having attained thus much, he will be qualified 
to commence the kind of observation necessary to prepare his 
mind to estimate the marks of debility, as it exists in differ- 
ent diseases, and in different patients. 

After these general remarks, we are prepared to notice 



202 STRENGTH AND DEBILITY, ETC. 

some particular kinds of debility, as explanatory of our views. 
There is one which is expressed by a sense of langour and 
lassitude, which comes on abruptly, and the cause of which is 
scarcely known by the subject of it. This is the kind of de- 
bility, which is felt often at the commencement of fever, and 
is almost universally the effect of a general fulness of blood, 
or of a morbid determination of the circulation on the brain, 
or of an introversion of it upon the abdominal viscera. A 
condition of things analagous to this, is found to obtain 
whenever any important viscus is in a state of congestion. It 
is the more necessary, therefore, to be able to distinguish it with 
certainty j because the kind of cordial treatment, which would 
be correct and beneficial in a case of debility, properly so call- 
ed, would be highly pernicious in this. Physicians have 
very correctly given to this kind of weakness, the appella- 
tion of indirect debility, and so long as it is kept up by ple- 
thora or congestion, the general plan of treatment must be 
evacuant. And in fact, this kind of practice must ordinarily 
be continued until the system shall be reduced to the state 
which is distinguished by the appellation of direct debility. 

Direct debility, as we propose to distinguish it, is debility 
in consequence of depletion, inanition, or exhaustion. The 
organization of the system is to be considered as being entire ; 
or if any organic injury may have had, or still has a place in 
any instance which may included in the definition, it is to be 
viewed as already cured, or fairly taking on the condition 
which we call convalesence ; or at the worst, a disease ac- 
knowledged on all hands to be a disease of debility. It may 
be produced by loss of blood, either suddenly and copiously 
abstracted, or by being frequently repeated in more mode- 
rate quantities. It may be produced by catharsis, diaphorsis, 
emesis diabetes, inanition, or by protracted disease, as dysen- 
tary, &c. In each and every case of direct debility, cor- 
dials, suitable diet, and management, constitute the proper 
remedies. 



203 

There are however a great variety of intermediate shades 
or modifications of debility, the result of circumstances which 
take place under the observation of the physician ; in which 
there is an obvious participation of both direct and indirect 
debility ; sometimes the one and sometimes the other, being 
most conspicuous. These apparently contradictory circum- 
stances, take place in many instances of organic disease, and 
in almost all which become chronic. We have preferred the 
use of the term intermediate, because the cases in which they 
occur, require a treatment which necessarily contemplates a 
qualified and variable course ; such as accommodates itself to 
the peculiarity of the case. That is to say, we alternate the 
use of tonics and cordials with that of suitable evacuations ; 
or we employ such a combination of agents, as is thought to 
produce a mediate effect. Such is the calculation in the use 
of alteratives. 

There is yet another distinction to be noticed, a species of 
debility, which is produced by too long a continuance in 
cold and damp places, or in places not sufficiently ventillated, 
or from which the solar light is excluded. In all these the 
atmosphere is more or less insalubrious, and vital heat is im- 
perfectly sustained. Something very nearly resembling the 
same condition of things, may be produced, by living on in- 
nutritious diet, or by too rigid abstinence, long continued. 
It may befall persons engaged in sedentary employments, 
and more particularly such of this description, as habitually 
use tobacco, snuff, or opium. In all the cases there is a sim- 
ilarity of appearance. The subject of it is pale, wan and in- 
dolent ; the arterial action feeble and inefficient ; the arteri- 
al tube small, and apparently elongated ; that is, the pulse is 
cord like. The very imperfect manner in which the blood 
is propelled to the extremities is obvious, the red particles 
are not visible in the skin. After these appearances have 
continued a sufficient length of time, the absorbent system 
begins to fail, which is evinced by oedematous swellings of 



204 STRENGTH AND DEBILITY, ETC. 

the lower extremities. The tongue becomes tremulous, 
which with the gums become pale. In all such cases, in 
whatever way the debility may have been induced, there 
will be a constant tendency to a concentration of the blood 
in the vessels of the viscera, and sooner or later, the continu- 
ed distention of the intestinal vessels, must superinduce some 
sort of organic injury. The different viscera are not all 
equally liable to be thus affected, nor the same organs in dif- 
ferent persons. The pallor affords visible evidence that the 
skin fails to perform its proper functions, consequently the 
lungs are compelled to sustain preternatural elaborations, by 
which they frequently become irritated, and take on latent 
and chronic phlegmasia, terminating in phthisis. In those 
who are brought into this state of debility by living on in- 
nutritious articles of diet, appearances present themselves in 
form of dyspepsia, cholic, flatulence and eructations, which 
appearances give notice of the failure of the abdominal vis- 
cera. The spleen or liver or all the blood making organs 
become disordered ; very often the lymphatic ganglions of 
the mesentery are involved in the common ruin, which is 
made manifest by an enlargement of the abdomen attended 
with marasmus. 

Here it may be proper to remark, that the reverse of all 
this is sometimes exhibited, when some one or more of the 
important viscera are diseased, and all the appearances of de- 
bility which we have described under this head, are exhibi- 
ted as the effects of the diseased organs. In almost all cases 
of this sort, and in many of the former, after the debility has 
long prevaled, there is produced in the system a predisposi- 
tion to turgesence of the cellular substance, and of those ves- 
sels, generally, whose office it is to elaborate and circulate 
the transparent fluids. It is believed, that this is most com- 
monly the case, when the subject of it is marked with the 
peculiarity of structure which we have described under the 
distinction of the lymphatic temperament. Ordinarily the 



205 

first visible indication of this state of things, appears in an 
oedematous swelling of the feet and ankles. 

We have considered the instances of debility, last describ- 
ed, as they appear, when produced by remote causes acting 
o n the system according to general laws, and treated the dis- 
eased condition of particular organs, as being consecutive on 
the long continuance of the debility which is followed by 
morbid determinations of excitement, and subsequent disor- 
ganization of those viscera, or structures, which become af- 
fected. Although these views will often correctly apply, 
yet a majority of all such invalids, wherever found, will 
have had the commencement of their indisposition in some 
organic disarray ; in some nucleus of congested vessels, which 
subsequently spreads itself, by an inoculation of the adjoining 
and corresponding parts, but often spreading itself so insidi- 
ously, as scarcely to produce painful sensation, even in the 
organ in which it is seated. And this state of things ought 
to be suspected, in any or all of those cases, of whatever 
rank, age, sex, or condition in life, where the invalids com- 
plain of weak lungs, dyspeptic stomachs, weak and irritable 
nerves, &c. &c. For want of this precaution, it has often 
happened, that tonics, stomachic bitters, assafcetida, castor, 
ether and opium, have been administered, when they served 
only to amuse and destroy ; and in fact, it was necessary to 
have had recourse to remedies, which are effectual to remove 
organic disease. In many instances of debility consequent 
on a chronic affection of some organ, the susceptibility of 
injury from the improper use of stimulants, is greatly in- 
creased. Not merely a predisposition to morbid action ex- 
ists in the affected organ, but an inflammatory condition of 
the subacute distinction, has become habitual, and the inevi- 
table result must be, an increase of disease and of general de- 
bility. A recent irritation, set up in any part or organ, of a 
person in possession of ordinary vitality, will speedily pro- 
duce a general disturbance, more or less violent, which will 



206 STRENGTH AND DEBILITY, ETC. 

be expressed by the ordinary appearances of pyrexia. But 
a chronic local affection, to the irritation of which the system 
has become accustomed, often progresses without exciting a 
general sympathy, and stimulants might in many instances 
be administered to an indefmate extent, without rousing the 
system sufficiently to exhibit a general fever. 

With these remarks on the subject of debility properly so 
called, we return to our former position, that indirect debility 
requires to be treated with evacuation : and we here repeat, 
that it is necessary to reduce the powers of the system, down 
to the condition which is direct debility. The lassitude and 
prostration of strength which attends the onset of fever, is 
the effect of a plethora. This fullness, under the pressure 
kept up by the impulse of the heart, supplied with the whole 
volume of sensorial power, subjects the pulmonary artery 
and indeed the whole arterial system, to an overwhelming 
injection ; so that the heart itself is enthralled by the un- 
yielding fullness of the two great arterial trunks, which is 
inevitably followed by a sense of indirect debility, of fullness 
in the chest, whilst the thorax seems begirt with an unyield- 
ing bandage, or pressed down with an insupportable weight, 
producing a sense of stifling for want of breath. Such a 
state of things, if not relieved by copious blood-letting and 
other suitable evacuation, would soon terminate in death. 
The evacuations must be continued until the quantity of 
circulating fluids is completely under the control of the pro- 
pelling power, and of the returning circulation of the system. 
If no lesion be produced by the injection before the circula- 
tion is relieved by such a sufficient depletion, the case will 
not be followed by pyrexia. But if the vessels shall have 
been injured by the distension, it then becomes necessary to 
evacuate not only to the degree just named, but to extend it 
so far, as to induce the state of things which is direct debil- 
ity, and by appropriate repetition, to secure a continuance of 
that state, until the system shal] have had the necessary time 



ETC. 207 

to repair the injury. The irritation which follows in such 
cases, and which provokes and maintains pyrexia, is conse- 
quent on a certain extent of capillary congestion, the removal 
of which, depends on the process of absorption ; which pro- 
cess will not be performed advantageously, until the system 
is placed in a condition of direct debility. 

The same doctrines ought to be admitted in our therapeu- 
tics in regard of chronic affections, in which we almost uni- 
versally have to encounter more or less general debility. In 
these cases, the diseased organ or structure is considered as 
being in a state of congestion, or at least in a state of irrita- 
tion ; and although the strength of the patient in the aggre- 
gate may be below par in view of any given standard, yet 
very often some depletion is necessary, in order to place the 
absorbents in a favorable condition. 

Take a few instances by way of elucidation. The debility 
which ushers in and attends on a case of pulmonitis, is al- 
ways the effect of embarrassed circulation. In gastritis, &c. 
the great prostration which attends, is partly the effect of 
fullness, but probably more the result of the inconvenience 
which the nerves of the stomach and intestines suffer, when 
those organs are brought into a state of inflammation. Inva- 
lids are rarely if ever attacked, after the manner of those who 
are overwhelmed with plethora. Such persons if predisposed 
to organic affections, resist them longer ; and in a manner 
peculiar to their condition retain their usual strength to a 
later .period, than those who are more robust. This last is 
an important fact. For if we should conclude that weakly 
persons must be treated with cordials, when they require de- 
pletion, the mistake will as certainly be fatal to them, as to 
those who are more robust. It is equally absurd to fortify 
such invalids against a sickly season, by giving them tonics, 
bitters, &c. or to brace up those who have narrow chests, or 
peculiar susceptibility of inconvenience from change of tem- 
perature, by similar means. The same may be said of those, 



208 

who advise stomachics and bitters, because the stomach is 
affected with symptoms of dyspepsia. Such prescriptions 
can do no good. On the contrary, they may establish the 
organic mischief which is already beginning, insidiously, to 
undermine the lives of the patients. From the whole it will 
appear, that much care is required to ascertain, in every case 
of debility, whether it must be placed to the account of the 
direct or indirect distinction. Also that experience alone can 
prepare us to adjust the practice, to the one or the other, and 
still more to perceive the occasions calling for the requisite 
modifications in treating the cases which need an alternation 
of cordial and evacuant remedies. 

A knowledge of the trades or professions of our patients, is 
often highly useful in conducting our pathological inquiries. 
And when it can be ascertained, that the disease under con- 
sideration has been produced by the profession, and especial- 
ly when known to be peculiar to it, it is often necessary to 
advise a change of business. If called to a man affected 
with a violent and unyielding cholic, with great and obstinate 
costiveness and hardness of the abdomen, it would be impor- 
tant to ascertain, whether he is a workman exposed to the 
effluvia of lead, or one who habitually handles substances of 
which lead is a component part. This kind of inquiry how- 
ever more properly appertains to a treatise on the causes of 
diseases and perhaps we may find occasion to notice it again 
under that head. 

The influence of habit is no less extensive than it is pow- 
erful in modifying the condition of the animal economy. It 
is therefore always important, that the physician should be 
acquainted with it. If any particular habit shall become in- 
veterate, health cannot be supported if it be laid aside too 
abruptly. Those habits to which we here refer, are such as 
relate to clothing, drink and diet. A man accustomed to eat 
largely as his daily habit, cannot always suddenly become ab- 
stemious, without inconvenience and danger, Those who 



STRENGTH AND DEBILITY, ETC. 20^ 

are accustomed to take ardent spirits, must not be deprived 
too suddenly of all stimulating drinks. We must gradually 
diminish the quantity and strength of the customary article, 
or we must devise a substitute. Facts have demonstrated, 
that inflammatory diseases are less frequently mortal among 
drunkards, if we allow them a small quantity of weak wine, 
and as the lives of such men are very frequently injured by 
long continued excesses, a strict attention should be paid to 
this circumstance in order to afford them every possible ad- 
vantage. 

Habits of dress require a similar attention. Some people 
accustom themselves to wear much clothing ; others little : 
some as to the whole body ; others as to certain parts of the 
body, as the head, breast, feet, &c. These peculiarities, ap- 
parently of little importance, should not escape our notice. 
Ordinarily, some real or imaginary cause leads to the habit, 
which ought to be investigated. By habit, the skin, or 
stomach, or schneiderian membrane, becomes less sensible of 
the stimulant, or irritating effect of any agent which may be 
be applied daily to them. If we wish therefore, to keep up 
the effect, the application must be gradually made more ac- 
tive. Tobacco chewers, andsnuffers, and dram-drinkers, all 
learn this instinctively, and sometimes, when any particular 
article loses its effect, it is found useful to discontinue it for 
a season, until the nerves which have beceme benumbed shall 
have had time to recover their ordinary sensibility. It is 
known that the most poisonous substances become apparent- 
ly inoffensive if used habitually, with gradual augmentation 
of the quantity taken. Yet this fact does not justify an in- 
cessant use of very active medicines. For, although their 
effects may be imperceptible, they may be deleterious, and 
eventually end in destruction. The skillful physician guards 
against the evil in both respects. He gradually increases or 
diminishes, so as to produce the intended effect, or withholds 
14 



210 



STRENGTH AND DEBILITY, ETC. 



it altogether, if it be found to produce irritation. This role 
is one of the greatest importance. 

The particular fancies or antipathies of our patients, often 
furnish us useful instruction. Some persons cannot take a 
particular article of food or drink. We ought to be inform- 
ed, so as not to advise either. There are some, who are sub- 
jected to a very inconvenient degree of sickness on taking 
an emetic, and yet cannot be made to vomit. If an emetic 
is deemed particularly necessary, in such a case, we ought 
not to use any article known to the patient as an emetic. 
An infusion of ipecacuanha, or warm water alone, should be 
administered in large quantities, until the effect is produced. 
It would be tedious to enumerate all the circumstances of 
this kind, requiring attention. There are but few persons 
who have not some antipathy or partiality for some particu- 
lar alimentary or medical substance : and it is always im- 
portant that the physician should acquaint himself with it. 
We have often known serious inconvenience to occur from 
inattention to this rule. 

Particular appetites produced by sickness too. claim the 
attention of the therapeutist. These appetites frequently call 
for very dangerous substances, and we must guard against 
their indulgence. Instinct often leads a suffering man to as- 
sume a convenient position of his body, or to make use of a 
a suitable beverage. There is some difficulty in deciding when 
it is proper to obey these calls of nature, and when to refuse 
them. They may be the result of morbid sensation, and of 
course are symptoms of the existing disease. If it be known 
that a healthful condition has not been restored to the viscera, 
that is, if the disease is still raging, appetites for food or stim- 
ulating drinks, ought always to be considered as being mor- 
bid, and they cannot be satisfied without danger. The pru- 
dent physician will not hastily oppose every such expression 
of nature's demands. Patients sick with fever, and possibly 
too long deprived of suitable drink, not unfrequently feel a 



STRENGTH AND DEBILITY, ETC. 211 

longing desire to be refreshed with some kind of acidulated 
beverage. With suitable precaution, they ought always to 
be indulged. In too many instances, patients in small pox 
have been smothered under an unreasonable weight of cov- 
ering, shut up in a close room, and drenched with saffron 
tea, at the same time that nature clamored loudly for light 
bedclothes, fresh air, and demulcent drinks. Thousands of 
the fair sex, in circumstances the most interesting to human- 
ity, have been subjected to similar treatment. When in- 
stinct, as a faithful monitor in each of these cases, would cer- 
tainly have directed a proper treatment, had it not been op- 
posed by ignorant officiousness. It is the imperious duty of 
the therapeutist, to consider the state of his patient, and the 
known effect of the article or substance which is asked for, 
by him or his friends. If it promise to be useful, the patient 
ought by all means to be indulged. If, however, the article 
proposed be unsafe, then with firmness it must be withhold- 
en, but it must be done with tenderness. In a condescend- 
ing and persuasive manner, the physician must endeavor to 
convince him that it would be pernicious to indulge. And 
with a view of appeasing the feelings of the patient, he ought 
to be prepared to furnish some substitute, that may be safely 
used. Instances occur however, where it turns out that the 
most skillful may err, and the forbidden article is taken, 
not only without injury, but obviously with the most decid- 
ed benefit. In such an instance, address is required to es- 
cape censure. Ordinarily, the better and safer plan is at 
once to acknowledge the error. Then as opportunity serves, 
take occasion to satisfy those concerned, that the mistake 
grew out of too much solicitude for the safety of the pa- 
tient. 



212 CAUSES OF DISEASE. 



CHAPTER VII. 

THE CAUSES OF DISEASE. 

One of the most important inquiries of the physician has re- 
spect to the cause of disease. In obscure cases, the want of a 
distinct expression of the symptoms, or the wide extension, or 
multifarious diversity of the phenomena which present them- 
selves, makes it very difficult to ascertain the seat, and, of 
course, the true character of many affections. To discover its 
true pathology in cases of this sort, requires a great deal of saga- 
city. To interrogate the patient, or those about him in an ef- 
fectual and workmanlike manner, so as to make the investi- 
gation assume an aspect sufficiently dignified, and to inspire 
a proper degree of confidence, patiently to hear the details 
with their appendages, however unmeaning; to collect such 
auxiliary information as may be obtained from such materi- 
als ; and then, by the more certain employment and exercise 
of sight and touch, to secure an intelligible and satisfactory 
view of the case — this is a task indeed. Experience alone 
can teach how difficult it is to obtain the truth from patients, 
either as it relates to the causes of their sicknesses, or the symp- 
toms by which they were ushered in. In making these re- 
marks, we do not mean to confine them to those complicated 
or hidden circumstances which require scrutinous investiga- 
tion. AVe include the most simple facts and appearances, 
such as it would seem, could not escape the notice of the pa- 
tient. 

To judge from the treatises which have been written and 
published for the use of medical students, they might be led 



CAUSES OF DISEASE. 213 



to suppose, that there is nothing easier than to retrace the 
circumstances which mark the formation of disease. It is a 
fact nevertheless, that no investigation can be surrounded 
with more obscurity, or be more likely to lead to erroneous 
conclusions. Men are strongly inclined to disguise the true 
origin of their complaints, and present circumstances and 
symptoms which have no relation to the case in hand. 

After having ascertained the seat of the disease, we have 
to inquire for the cause which produced it. For instance, 
disease produced by working in lead, by using tobacco, or 
manufacturing it, or by following sedentary avocations, &c. 
If well acquainted with anatomy and physiology, we shall 
always be prepared to form opinions, satisfactorily correct. 
Guided by these, we are prepared to overlook those occult 
and hypothetical causes, which took the attention of physi- 
cians in former times, and investigate the. state of any viscus 
which is the seat of disease. Irritation, produced by what- 
ever cause, must be corrected. In any case of enteritis pro- 
duced by worms, it may sometimes be necessary to reduce 
the inflammatory condition of the intestines, before we have 
recourse to anthelmintics. So also in most cases of com- 
pound fracture, it will be necessary to leave the reduction 
incomplete, until the inflammation subsides, which may re- 
quire several days, because the unavoidable disturbance of 
the fractured parts in operating on the limb, would produce 
a greater mischief. In treating a case of opthalmia, the con- 
dition of the general system is first to be regarded ; local 
applications are after considerations. 

The kind of acute attention which we recommend, will be 
well exemplified by a case which has been reported by a dis- 
tinguished French physician. A female was supposed to be 
indisposed with a disease of the chest. She had a torment- 
ing cough; a very distressing sense of suffocation frequently 
recurred ; to these were added a continual head-ache ; dizzi- 
ness i a full, hard, and slightly accelerated pulse. In conse- 



214 CAUSES OF DISEASE. 



quence of a sudden surprise, catamenial evacuations had ceas- 
ed for ten months. A copious blood-letting produced a ces- 
sation of the painful affection of the head. With a little at- 
tention the menstrual discharge was re-established ; but the 
cough and distressing symptoms of the chest continued. 
Further means were used for ten or fifteen days, but with- 
out success. At length she was observed by her physician, 
to perform that very remarkable motion which accompanies 
painful deglutition, and to perform it frequently. Her fau- 
ces were then for the first time examined. There was a 
slight irritation discoverable in the pharynx and tonsils, the 
palate was elongated and filiform, and descended along the 
root of the tongue, very near to the epiglottis. This was 
the true cause of the cough. The exuberant appendage of 
the pallate was taken off, and all the symptoms disappeared. 
Circumstances similar to these are not uncommon ; and the 
superiority of modern anatomy will enable us, generally to 
detect them in a shorter time than even the acute French- 
man required to make this discovery. 

On visiting the sick room, after decent but short saluta- 
tion, the first duty of the physician is to examine the condi- 
tion of the patient, and ascertain which of the organs is in- 
jured, in a way calculated to exhibit the phenomena under 
his observation. His researches into the circumstances per- 
taining to any disease, his discoveries in regard of any de- 
rangement in the principal functions, all his investigations 
intended to ascertain the diagnostics of different morbid af- 
fections, have for their object and their end, a proper know- 
ledge of the parts primarily affected by the disease. Having 
obtained a suitable acquaintance with the hurtful agent, 
which is the cause, and the manner in which it acts in the 
production of disease ; then with a knowledge of the organ 
or organs which are affected, the physician is prepared to 
conceive justly of the train of injuries which may have been 
sustained, and understand the phenomena which are from 



CAUSES OF DISEASE. 215 



time to time developed, to institute an appropriate curative 
intention, and employ the medicament which will be most 
effectual; 

Without ascertaining the true seat of the disease, and the 
condition of the organs which are concerned, there are many 
diseases which cannot be understood in a manner calculated 
to insure a safe practice. There are affections of the viscera, 
which involve the nerves in such a degree as to produce 
convulsions. Sometimes worms produce the same appear- 
ances. Severe convulsions frequently occur on the com- 
mencement of a paroxysm of intermittent fever. A proper 
knowledge of the causes and seats of diseases, is without 
question the true basis of correct pathology and successful 
therapeutics. 

It is necessary to know the organ which is the seat of dis- 
ease, in order to select the most suitable remedy. In cases 
of inflammation of the lungs, we depend chiefly on blood- 
letting. In hepatitis, after the necessary blood-letting, we 
rely more emphatically on cathartic agents. In enteritis 
more bleeding is necessary, according to the apparent strength 
of the pulse, than in most other diseases, and absolute absti- 
nence should be considered more rigorously indispensable 
in inflammatory affections of the alimentary canal, than 
in almost any other instance of inflammatory condition, 
except in a case of phrenitis. Digitalis, which is so useful in 
regulating the action of the blood-vessels in some instances 
of capillary congestions of the vessels of the thorax, is of no 
value, in fact it does injury in an ordinary inflammation of the 
lungs. Cantharides are hurtful to those whose bladder is in 
an irritated state, but greatly useful in cases of debility of 
that organ. 

We should be careful in the study of pathology, to keep 
our knowledge of symptoms constantly associated with the 
organs to which they are allied. As articulated sounds are 
altogether unmeaning, except they are the known expressions 



216 CAUSES OF DISEASE. 



of certain ideas, so symptoms are of no value except they in- 
dicate pain, or some other affection of a known organ. No 
solid objection can be raised against an effort to arrive at this 
kind of knowledge, on account of the fact that post mortem 
appearances give information only as to the state of things 
which occurred at the last hour. This difficulty might have 
more weight, if death never could take place until after the 
organs had run through all the changes which are implied in, 
their total disorganization. But this is not the case. In- 
flammation can destroy life, sometimes in a few hours, often 
in a few days ; and yet, sometimes chronic affections ending 
in death, may run on for months, and even years. Observa- 
tion has ! in fact taught us, how long time, under given cir- 
cumstances, is necessary for the formation of pus, for the 
thickening of membranes, and other disorganizations. With 
practice and attention, probable estimates can be made, judg- 
ing by the violence of the symptoms and the time and cir- 
cumstances of the case, what the actual state of the diseased 
parts may have been. We cannot fail to perceive how pa- 
thological anatomy in aid of scientific physiology, may 
contribute to the improvement of medical science, and of 
course, how important it is, that we should carefully im- 
prove every opportunity offered us for extending our re- 
searches in this way. 

Independently of all other considerations, whether they 
may have respect to the disease in question, or to the patient, 
the intensity of a pathological affection frequently requires 
very remarkable modifications in the curative measures which 
are to be adopted. In a violently inflammatory disease, we 
must have recourse to blood-letting, aud this must be repeat- 
ed, sometimes frequently and in quick succession. The 
most rigid abstinence from food and from stimulating drinks, 
must be prescribed, and in a word the practice must be as 
decisive as the disease is violent. Any temporizing or half- 
way measures might be fatal. The time when the cure 



CAUSES OF DISEASE. 217 



ought to have been accomplished will have gone by, and nev- 
er can be recalled. Bat when the disease is mild, we use 
means of less power, take more time, and confide more cer- 
tainly to the recuperative powers of nature. Moderate evacu- 
ations, rest, and plentiful dilutions, in such cases may be safe- 
ly trusted. To judge with certainty and propriety of the 
true grade of the disease, the power of the agent which shall 
be found to accord with the strength of the patient, and of 
course to do all that ought to be done, and no more ; this is 
the consummation of medical skill. 

It was once deemed essential to good practice to regard the 
critical days — third, seventh, ninth, eleventh, fourteenth, sev- 
enteenth, twentieth. On each of these days, it was thought 
necessary to make especial effort to assist the powers of na- 
ture to bring about a crisis. All this is now nearly laid aside. 
Regard is had to the duration of the disease, but this only 
with a view to keep a proper estimate of the patient's 
strength, and to judge of the obstinacy of the disease, with 
which we are contending. In the commencement of enter- 
itis, we use a kind of practice which would be altogether de- 
structive after the patient shall have been prostrated by a long 
continuance of the disease. When an abscess is threatened 
we use one kind of treatment in the commencement, (I mean 
whilst inflammation prevails ;) another after suppuration shall 
have been completed. And there are times and occasions in 
all cases of phlegmasia, which we ought to recognize and 
improve, in order to insure success in their treatment. In 
the commencement of inflammatory affections, it is always 
important to deplete with the degree of decision, necessary to 
guard against congestion ; and very often in performing this, 
a disease, which, if left to nature's powers unaided, would 
probably continue twenty days, and perhaps destroy life, re- 
tires completely in consequence of the first day's treatment. 

We would be understood to teach a doctrine the reverse of 
what was contemplated, when the critical days were estab- 



2lS 



CAUSES OF DISEASE. 



lished. Physicians, then, looked for a day, which would 
invite particular attention to nature's movements, that they 
might be in readiness to help her to fetch her lingering step 
over the summit ridge of the disease, that she might have the 
opportunity of a comfortable walk down the slope of a linger- 
ing and uncertain convalescence. We insist on a bold and 
successful attempt to arrest the disease at once, and then 
leave to nature her well known work of taking care of herself 
in her ordinary way. The first day's treatment is all-impor- 
tant, and in many instances it will insure the life or death of 
the patient. 

It is the practice of some, to try to perform something like 
this in the commencement of pulmonary catarrh, and in pain- 
ful affections of the stomach and abdominal viscera, by quaff- 
ing down large doses of alcohol, ginger tea, and the like : 
and then covering themselves heavily in bed, expecting to 
correct the existing error by provoking an abundant sweat. 
Physicians may be considered in some degree to imitate this 
pernicious practice, when, without previous blood-letting, 
they administer tartarized antimony in the commencement of 
such affections. It is true, the shock produced by an emetic, 
when it chances to be followed by a general and equable 
excitement, may answer a very useful purpose. A copious 
perspiration or a free secretion from the kidneys, may correct 
the irritation and produce an artificial crisis. But any attempt 
in this way, will prove abortive, whenever there is consider- 
able plethora or very strong arterial action. Indeed, it will 
make the case more morbid and more difficult to cure, when 
through failure in the first attempt, recourse shall be had to 
more appropriate measures. The patient will be subjected to 
dangers he needed not to have encountered. It may be proper 
to admit, that we may sometimes adopt a rational plan of 
treatment and go on to execute it with suitable decision, and 
after all, fail to effect the changes which we intend. Having 
been sufficiently circumspect in adopting our plan, there is 



CAUSES OF DISEASE. 219 



no alternative but to reiterate the effort again and again, ta- 
king care, however, to accommodate the means to the inces- 
santly decreasing strength of the patient. If we commence 
with blood-letting, after a certain number of repetitions, 
blood-letting can no longer be employed, and reliance must 
be placed on milder remedies, such as under existing circum- 
stances may have a known tendency to remove the remaining 
irritation. It is proper to remember, also, that a disease 
which is inflammatory in its character, does not change its 
nature nor cease to require the employment of therapeutic 
means, proper for correcting irritation, although it may be 
protracted into a chronic form. In the meantime, however, 
the necessary modifications must be made in view of the tis- 
sue or organ which is the seat of it, and of the length of 
time, through which it may have been extended. 

We reject as absurd, any routine or system of set practice, 
such as would make it necessary to administer an emetic in 
the commencement Qf all bilious or catarrhal affections ; and 
also such as would make it equally imperious in all cases of 
debility, to administer tonics and stimulants. Such treatment 
must be conducted without regard to the nature, seat, and 
consequence of disease. In either case, much injury is to be 
feared, and the good which is sometimes apparently done by 
it, is too uncertain to justify the practice. By improper at- 
tempts to cure fever of serious character, without blood-letting 
and other suitable depletion, the cases so ill treated, become 
protracted, exhibiting foetid excretions, foul and black tongue, 
accompanied by a general disposition to that form of fever 
which in former days was called putrid. In the hands of a 
workman we seldom meet with such cases. Furious deliri- 
um, hydrophobia, spasm, and convulsions, which so fre- 
quently occur under bad management, are commonly avoided 
by a treatment which is really skillful ; and true skill, we 
hope to show in the proper place, will not fail to employ 
what has been called the antiphlogistic treatment, to a greater 



220 CAUSES OF DISEASE. 



or less extent, in almost every case. By this rational method, 
a greater number of cases will be cured, and even when cures 
cannot be effected, while life lasts, the symptoms will be 
moderate : even death is stripped of those formidable appear- 
ances which never fail to attend, when important viscera are 
still gorged with blood, or their blood-vessels are ruined by 
fatal congestions. 

In addition to all the foregoing considerations, we must 
also have respect to the influence of climate. Every man 
shows some sign, which is the effect of the climate which 
gave him birth. His physical organization, his habits of 
eating or drinking, even his moral character and degree of 
sensibility, are all more or less modified by the country in 
which he has long resided. The philosopher, moralist and 
physician, all read Hippocrates with equal interest, where he 
describes the characters of the different nations of people 
known at the time when he wrote. Such is the excellence 
of his account of them, that the illustrious author of the 
spirit of laws (Montesquieu) could scarcely make any useful 
addition to it. Time has not materially changed the pow- 
erful effect of the laws of climate. In Holland, which is a 
cold and damp plain, the skin often chilled, performs its func- 
tions imperfectly; the lungs from that cause are subjected to 
an unnatural exertion in the performance of their functions. 
In our low countries and in flat marshy regions generally, 
persons who can survive, acquire the physical power to live 
with less blood in their skins. The consequence is. chronic 
irritation and ultimate disorganization of the lungs, the pre- 
lude to phthisis pulmonalis. Through the torpor of the skin, 
the cellular substance and ultimately the whole system o{ 
lymphatics, becomes affected, paleness, bleating, dyspepsia 
and dropsy, are likely to follow in their train, to sweep away 
those who may escape pulmonic affections. 

How great the contrast between these people and those 
who inhabit the equatorial zones. Here the tissues present 



CAUSES OF DISEASE. 221 



a texture corresponding to our ideas of most perfect symme- 
try, the nervous system susceptible of every impression, even 
to excess. The muscular system is less vigorous and a pre- 
vailing inclination to voluptuousness distinguish the inhab- 
itants of Asia. The abundant fertility of the soil renders it 
easy to procure the means of living, and the heat of the cli- 
mate invites to indolence, so that he is almost constrained to 
prefer a careless and sedentary life, and suffer his bodily vigor 
to sink into effeminate weakness. The habitual stimulus of 
the sun's rays, maintains an equable excitement, and in a 
very peculiar manner promotes a healthful condition of the 
digestive organs. A short life of pleasure, is of course, the 
lot of this people. Contemplate such a people in the posses- 
sion of riches and repose, surrounded with pleasures, and you 
will readily perceive how the inhabitants of a northern cli- 
mate, poor, rough and inured to hardships, were always able 
to make them an easy prey. And you will understand how 
the conquerors in turn, became as effeminate and voluptuous 
as those whom they had vanquished. Hardihood, with little 
nervous irritability, their sympathies of course not easily en- 
listed, their organs firm and well balanced performing with 
facility all their proper functions, an ability to endure fatigue 
and all the vicissitudes of the weather, wet or dry, hot or 
cold, such are the distinguishing traits of the inhabitants of 
northern climates. The face of a country and the means 
which it affords for the support of its inhabitants, have a 
weighty influence over their physical and moral condition 
and character. In mountainous countries, of whatever lati- 
tude, where the people are chiefly dependent on the chase 
and hard labor for their support, we find a strong, vigorous 
and unconquerable race, always jealous of their liberties and 
ready to contend for or defend them. Whilst the inhabitants 
of fertile regions, where every necessary of life is furnished 
in abundance, almost without care, are tame, indolent and 
easily conquered. Daily labor performed from inevitable 



222 CAUSES OF DISEASE. 



necessity, can do more than any other thing for the attain- 
ment of a sound organic structure of the system and the es- 
tablishment of a vigorous.constitution. Indolence and ease, 
of course, as certainly produce effeminacy. 

In view of these considerations, the physician has two im- 
portant points to guard. The first is, to treat the natives of 
any country, according to their various temperaments and 
contingencies. The other is, to be vigilant to ascertain the 
effect the climate has on strangers, and its various effects on 
such as come from different regions. A deficiency in this 
kind of observation, has often led to the destruction of con- 
quering armies, in different ages of the world. 

The inhabitants of warm climates, when they pass into 
damp and cold regions, ought to increase the warmth and 
quantity of their ordinary clothing, and to be careful to in- 
sure a suitable degree of warmth to the system every night 
by using warm and gently stimulating drinks, &c. Their 
diet should be light in quantity, but consist of substantial 
materials, indulging moderately in the use of wine or very 
dilute alcoholic beverages. 

When the inhabitants of higher latitudes pass into the hot 
climates of southern regions, it is necessary for them to use 
vegetable diet chiefly, and flesh very sparingly. And what 
may seem strange, at first view, their night dresses ought to 
be warmer than they are accustomed to wear at home. They 
too, should use a suitable hot beverage on retiring to bed, and 
regard the utmost temperance in every thing. 

Persons necessarily going into marshy countries, where 
bilious and intermittent fevers abound, or where yellow 
fever, cholera, and dysentery, commit their ravages on the 
inhabitants, should be careful, in all the above named partic- 
ulars, and at the same time, avoid those districts where the 
miasm is known to abound. Every kind of excess or intem- 
perance ought to be avoided, as if they were infallibly sure 
to destroy their unfortunate victims. 



CAUSES OF DISEASE. 223 



There are other circumstances in relation to climate, 
which must be regarded in prescribing medicines. To the 
vigorous inhabitants of northern latitudes, who have a fast 
hold on life, we may administer our maximum doses, of 
whatever article it may be proper to employ; such as copious 
and decisive blood-letting, and bold cathartics. Those of 
such as have been accustomed to the use of ardent spirits, or 
very hearty meals, must not be subjected to too much abste- 
miousness, and if stimulant means are required, they must 
be dispensed with a liberal hand. 

Among the natives of equatorial regions, strict diet, de- 
mulcent drinks and pleasant palliatives, in aid of minimum 
doses of appropriate medicines, will be all-sufficient. It is 
desirable that a more extended investigation should be made, 
and more careful observation encouraged, in order to ascer- 
tain what particular organs are most liable to surfer injury 
from the known ^different climates, and what the kind of 
modification which such particular organs assume, under the 
influence of particular climates. The result of such a course 
of inquiries, if happily and successfully executed, might be 
properly enough denominated medical geography. 

We will conclude with some miscellaneous remarks, such 
as we could not conveniently introduce under any of the 
foregoing distinctions. 

Attention must be paid to the state of the patient's mind. 
Sometimes there will be occasion for the greatest skill in reli- 
gious and moral concerns, in order to restore the necessary 
tranquility of the patient, tormented with unnecessary fears. 
Sometimes, on the contrary, we meet with such unconquer- 
able antipathy to the use of medicine, that it becomes indis- 
pensably necessary to make the patient understand, that the 
dangers of the case are such, that not only a few doses, but 
perseverance in the use of medicine will be necessary 
to prevent threatened dissolution. Much good sense is 
necessary for the proper performance of either of these 
duties. 



224 CAUSES OF DISEASE. 



We must also have regard to the effect and the demands of 
the passing seasons. A physician of acute observation is al- 
ways prepared to meet the variations produced in the types 
of the different forms of fever, which occur as the seasons 
roll round ; so that he may be sufficiently on the alert, not to 
be taken by surprise. Besides, the kinds of drinks, and the 
various attentions which are requisite, are also modified by 
the seasons. During the heat of summer, acidulated and 
cold drinks, affusion, sponging, wiping, &c. are particularly 
comfortable and useful to the patient. In most instances, 
cleanliness and ventilation in the sick room, the speedy re- 
tirement of the excrements, in a word, the physician ought 
to afford evidence, that he suffers nothing to pass unno- 
ticed, which can at all affect the comfort or the safety of 
his patient. It is greatly consoling to the sick, to see all be- 
coming solicitude for their safety constantly evinced by their 
physician. It increases confidence and contributes not a lit- 
tle to recovery. 

The young physician will take care to read the various 
treatises on the practice of medicine as common place : re- 
membering that not one, nor all of them together, can give 
an adequate description of the true state of any patient, or 
direct the therapeutics by which its management should be 
conducted. It is his province and his duty, to investigate 
his own cases like a workman, taking into view the sex, age, 
degree of strength, the manner of life, and the occupation of 
each. He must ascertain the seat of the disease : the degree 
of violence which marks its progress : the time it has existed, 
and circumstances by which the patient is surrounded : that 
is, the character and ability of the nurse, and the supplies 
which can be furnished for the sick room. After all these 
things shall have been duly examined and considered, the 
therapeutic indication and the details of the practice which 
are to follow, may be adopted in a workmanlike manner. 



PART III 



MATERIA MEDICA. 



15 



PART III 



CHAPTER I. 

INTRODUCTORY TO MATERIA MEDICA. 

Any substance which possesses the power of producing a 
remarkable change in the general action of the system of or- 
gans which constitute the human body, or in any one of those 
organs, which in certain cases tends to correct a disordered 
state of the functions, and restore their regular condition, may 
be considered a medical agent. We give the appellation of 
medicaments, more emphatically to those well known and 
tried articles, which having received an established character, 
have been modified or reduced to a fixed and settled form, 
and are now presented in a uniform shape, so as to render 
them most conveniently and extensively useful. The idea 
of a remedy necessarily implies some disease which the rem- 
edy is supposed to cure. All remedies are not properly me- 
dicaments, as many remedial articles are useful only as they 
may appertain to some Hygiene prescription, as others to cer- 
tain surgical operations. But all medicaments are to be con- 
sidered remedies, since we employ them exclusively with in- 
tention to cure disease. Aliments, medicaments and poison?, 
are not separated by any insuperable bounds. The state or 
condition of a patient may be such, that the most innocent 
and salutary aliments may become fatal poisons; we all 



22S l INTRODUCTORY TO MATERIA MEDICA. 

know that the most violent poisons can be employed as the 
most valuable medicaments. And the old adage is true, that 
what is an aliment to one man, to another is a poison. 
Nearly all the substances in nature's wide field, may be made 
useful to the therapeutist. It is the business of the physi- 
cian to select those whose efficiency has been established by 
the experience of the profession, regardless of its natural clas- 
sification, whether in common acceptation it be an aliment, 
a medicament or a poison ; to a proper extent following the 
example of the wise ancients, who confined themselves to the 
use of substances which were well known, and to the most 
simple preparations then in use ; when abstinence from food, 
vegetable decoctions, blood-letting, &c. were the items which 
composed their materia medica. But they became tired of 
this commendable simplicity, and combinations of substances 
the most active or fantastic, or even disgusting, in endless 
faragos, were made to encumber the pharmacopoeia,, until 
quackery, credulity, ignorance, and that universal mania, a 
taste for the marvellous, all concurred to hatch, multiply and 
scatter over the world, numbers of remedies, recipes, and se- 
crets. Such was the wretched state of things for centuries, 
and the materia medica continued to wear this appalling as- 
pect till about a century ago, when all at once the profession 
laudably set about a reform. The most conspicuous exam- 
ple perhaps, was set by the great Sydenham of England, who 
commanded admiration by his successful manner of treating 
diseases with blood-letting, antimony and opium, almost 
without other medicines. 

From that time to the present, this department has been 
gradually cleared more and more of the useless trash with 
which it was disgraced, until it may be said in truth that the 
reformation has been immense. Yet after all, articles are re- 
tained which ought likewise to be discharged. By retain- 
ing in our materia medica, substances, whose effects are 
equivocal., we inevitably make our therapeutics uncertain, 



INTRODUCTORY TO MATERIA MEDICA. 229 

But if we conform ourselves to the use of real medicaments, 
and use them judiciously, we shall continue to improve our 
own judgment and contribute effectually to the advancement 
of our science. If in this regular and commendable course 
of procedure, we can make accessions to the catalogue of real 
medicaments, it will be a source of true complacency to him 
who may discover a valuable improvement, and of gratitude 
to the profession and to the world. 

In administering our medicines, our attention should be di- 
rected, first, to the effect produced on the stomach, or on any 
other part of the body, to which its application is made. 
Secondly, to its effect on the whole vascular system, and on 
any particular organ. In the third place, to the condition in 
which it leaves the system, after its agency shall have ceas- 
ed. And lastly, to the ultimate effect which it may have 
produced in regard of the course and termination of the 
disease, for the cure of which it may have been prescribed. 

We shall not attempt to settle the question, whether me- 
dicaments produce their final effects, by the peculiar impres- 
sion made first on the nerves of the stomach, and by the laws 
of association on the whole nervous system, or by coming in- 
to contact with a greater number of ramifications of the 
nervous system by means of absorption. We believe both 
to be true. But the action of the medicaments cannot be ex- 
plained by any hypothesis predicated on chemical combina- 
tion. The laws of life and animal assimilation, are incom- 
patible with any such opinion. Their action cannot depend 
on any mechanical power, or impulse, made by them on liv- 
ing organs, nor by a tendency of the particles which enter 
into their composition, to penetrate the tissues, or the paren- 
chymatous substances which pertain to the viscera, and by 
combining, or uniting, with the animal substance, effect the 
changes which they produce. All we can know on this sub- 
ject is, that certain phenomena are produced by the use of 
certain agents. That these phenomena depend on the pecu- 



230 INTRODUCTORY TO MATERIA MEDICA. 

liarity of the impression on the part of the agent, and on the 
manner of feeling and the consequent motion produced by 
the impression on the part of the body which is the subject of 
the application. And although any particular agency may 
invariably produce a similar effect, however often it may be 
repeated, still the phenomena will vary according to the de- 
gree of susceptibility or irritability of the system, or of the 
particular organ which more immediately comes under its 
influence. This is a fact which should never be forgotten. 
By way of example • two drachms of the sulphate of mag- 
nesia, being administered to a healthy adult, would, ordina- 
rily, produce a very inconsiderable effect, yet this small por- 
tion, given to a person with an irritable state of the intes- 
tines, might produce a most alarming state of hypercatharsis. 
The impression in either case is of the same nature, but in 
the degree and extent of the cathartic effect, there is a very 
great difference • and this is owing to a difference in the 
state of the system, in the two cases. 

An epispastic or rubefacient application of limited extent, 
applied to the surface, or an appropriate lotion applied to the 
eye, or to the urethra, ordinarily produces effects which are 
limited to the surface to which the application is made ; but 
this is true only when the system is in a healthy state, or 
when the disease is such as readily admits of retirement. A 
weak solution of sulphate of zinc applied to the conjunctiva 
in a healthy state, will not produce an action implying any 
permanent inconvenience. But stimulate the eye when it is 
already irritated, and the local irritation will be increased, 
producing a general state of pyrexia. The same may be 
said in regard to the urethra. So also, agents given internal- 
ly. A moderate dose of quinine administered to a man in 
health, will only slightly raise the pulse, and when the stimu- 
lant effect retires, little or no inconvenience is found to re- 
main. The same dose reiterated a few times, in a case of 
inflammatory fever, unless the patient shall have been first 



INTRODUCTORY TO MATERIA MEDIC A. 231 

prepared by depletion, will be followed by speedy inconve- 
nience and very often by an increase of fever, which is af- 
terwards corrected with difficulty. 

Different remedies are applied in practice to the integu- 
ments, the conjunctiva, the schneiderian membrane, the ears, 
mouth, stomach, the rectum, and urethra. It should be re- 
membered that an agent which may be safely and usefully 
applied to one of these particular portions of the external or 
internal surfaces, may be extremely offensive to another. 
Vinegar, for instance, is perfectly pleasant in the mouth, and 
may be received into the stomach almost without perception; m 
yet if thrown into the eye, urethra, or rectum, it gives great 
inconvenience and in many instances would be followed by 
inflammation. Cantharides may be extensively and usefully 
applied to the cuticular surface, and the irritation and exco- 
riation which they produce, accord with sound philosophical 
therapeutics. If applied internally, so as to produce a simi- 
lar irritation, the consequence might be fatal. This is a 
discrimination, therefore, particularly worthy to be kept in 
recollection. 

There can be no doubt of the fact, that medical substances 
are absorbed. Of course that they act primarily on the or- 
gan or part with which they first come into contact, princi- 
pally the stomach ; that the impression made on the nerves 
of the stomach, is sympathetically conveyed to the nervous 
system generally, or to some particular tissue specially, or 
perhaps to both. And after sufficient time is allowed, cer- 
tain parts, at least of some agents, are taken into the circula- 
tion by absorption, and thus coming into immediate contact 
with a greater portion of the nervous system, serve either 
to increase the effect, or extend it through a longer period 
of time. 

According to these facts, those agents which are known 
by experience to act on particular organs, or to increase cer- 
tain functional operations, may be effectual, either directly 



232 INTRODUCTORY TO MATERIA MEDICA. 

or sympathetically ; but we are inclined to the opinion, that 
we are chiefly indebted to the sympathetic relations which 
obtain- among all the organs and functions of the body unit- 
ing and constituting them one great whole, for the most in- 
teresting phenomena which claim our attention, in regard of 
the modus operandi of the best medicaments known to the 
materia medica. The nerves of the stomach receive the im- 
pression of the agent employed, through them it is conveyed 
to the sensorium, when the whole system becomes generally 
interested, and such organs specially so, whose structures 

„ and functions are more particularly calculated to be most 
excited by the impression. Hence the sympathetic effects, 
that is, the supposed specific effect of medicaments are ordi- 
narily proportioned to the intensity of the first impression. 
Hence also the sympathetic affection in most instances, 

^commences, increases and terminates, with the correspond- 
ing phenomena, which give notice of the general impres- 
sion. 

We introduce into the stomach, wine, opium, camphor, 
oxymel of squill, kermes mineral, digitatis, &c, the ultimate 
consequence is, that one excites general action only, another 
induces sleep, another excites diaphoresis, another increases 
the secretion of urine, and another diminishes the power of 
the heart. The first impression is made on the stomach by 
each. The ultimate result differs in each, and experience 
alone can make us acquainted with the specific differences 
which mark their modus operandi. The same diversity of 
appearances attends when any of these agents are properly 
introduced into a vein. We make our applications chiefly, 
however, to the stomach, to the lower intestines, and to the 
skin. But these surfaces may vary in respect of their sus- 
ceptibility of the impressions which may be intended to be 
made, either on account of the state of the nerves generally, 
or of those of the stomach, &c. particularly. The whole 
system may be so prostrated, that the medicaments will pro- 



INTRODUCTORY TO MATERIA MEDICA. 233 



duce no sensible effect ; or the tone and sensibility of the 
stomach may be so reduced, that an ordinary portion of the 
most powerful agent seems to be quite inert. Let the ener- 
gies of any person be exhausted by great fatigue, and he may 
take an unusual quantity of any appropriate stimulant, not 
only without injury, but with manifest advantage. If the 
pneumogastric nerve of a horse be divided, you may give 
him as much of the nux vomica as would serve to kill 
him, had not the nervous communication been first cut off. 
If the stomach be in an irritable state, those agents which 
ordinarily soothe and tranquilize, serve only to increase irri- 
tation. 

When medicines are absorbed, it is not important to know 
whether the lymphatics or the veins are most concerned. 
The coloring matter of madder, the odoriferous principle of 
turpentine, camphor, alcohol, essence of lemons, &c. are 
found to pass into the blood, and are eliminated by the secre- 
tions. Then of course medicaments administered at any 
time will be more or less effectual, as the absorbent system is 
more or less ready to bear its part. But as to the various 
modes and degree of fitness or unfitness of the whole system 
of nerves, or of those of the stomach or of the absorbents, it 
remains yet unsettled. It is hoped that the zeal and indus- 
try of the profession, will not cease, until all that is necessary 
to be known, will have been ascertained and settled. 

In tetanus, either the assimilating power of the stomach is 
so much increased as to change the nature of very large por- 
tions of opium and prevent its usual effect, or else the stom- 
ach and prima vim are too insensible to feel, and the absor- 
bents of those organs too inert to convey it into the circula- 
tion. Enormous quantities are administered without any 
discoverable effect. In the same disease, this article intro- 
duced into the veins, acts in the usual manner. It has been 
long known that if injected into the rectum, opium is more 
effectual for the correction of nervous irritation, than when 



234 INTRODUCTORY TO MATERIA MEDICA. 

taken into the stomach. And in this view of the subject it 
is particularly worthy of remark, that any of the important 
medicaments which produce special effects as if by an elec- 
tive action on some particular organ, produce the same effect 
if introduced into a vein, which they always do when 
taken into the stomach, or if applied by friction on the skin. 
So emetics, cathartics, narcotics and diuretics, will severally 
direct their effects upon the stomach, the intestines, the brain, 
and the kidneys. Dr. Hale made an experiment on his own 
person, with ol ricini. It was followed by an oily and nau- 
seous taste in the mouth, pain in the intestines and with de- 
cided catharsis. Now if it could be ascertained, what articles 
most certainly admit of absorption, by what phenomena the 
physician is to judge of the effect, how to regulate, restrain 
or render more active, articles which may be safely used in 
this manner, it might become very important to the therapeu- 
tist. It would not only give a more extensive control over 
the maladies of the human family, but it would eventually 
contribute much towards a definite understanding of the mo- 
dus operandi of medicines. Perhaps much additional infor- 
mation might be collected, if practitioners would make more 
frequent, extensive and careful application of remedies to the 
skin. It is admitted that the stomach and intestines promise 
a more ready and complete absorption of medicinal substan- 
ces. But it is a fact that they possess elective and repellent 
powers also, and are protected by an exquisite sensibility. 
Besides, they are endowed with the power of assimilation 
which can modify, and to a considerable degree diminish, 
the power of any agent applied to them, so that the manner 
in which the system is primarily affected by them, must re- 
main very uncertain. In making experiments on the skin 
there can be but little difficulty and almost no hazard to the 
patient. Experiments by venous injeetion must necessarily 
be difficult and always dangerous. But we shall have occa- 



INTRODUCTORY TO MATERIA MEDICA. 235 

sion to say more on the subject of the skin in our subsequent 
chapters. 

There are some important considerations which ought to 
be kept in recollection, which regard the condition of the 
body after having undergone the operation of certain impor- 
tant medicinal agents. An emetic, for instance, when it 
may have been most distinctly indicated, and carefully and 
properly administered, often leaves the stomach in a state of 
irritation, which acid or fermenting drinks do not fail to in- 
crease, and sometimes they produce very serious effects. 
Narcotic substances, administered m portions, but a little too 
large, frequently leave the system in a dull, stupid condition, 
which may readily become dangerous. These inconvenien- 
ces should be foreseen and avoided. Blood-letting, at the 
same time that it reduces the arterial action temporarily, to a 
certain extent produces a converse effect on the nervous sys- 
tem, and if at all ill-timed will require an opposite treatment. 
If a person of nervous temperament be the subject of such 
treatment, and the error be not timely corrected, spasms and 
even convulsions may be induced. The application of the 
most emollient poultice, too long continued, might be fol- 
lowed by such a state of relaxation, as to require for its cor- 
rection, the use of roboratives and tonics. It is important 
that we be prepared to anticipate the immediate and secon- 
dary effects of the various agents which we employ. A de- 
ficiency in this kind of information, might not only endanger 
the life of our patients, but must inevitably endanger the 
reputation of the profession. 



236 MEDICAMENTS, 



CHAPTER II. 

THERAPEUTIC POWER AND VALUE OF MEDICAMENTS. 

After the foregoing prefatory remarks, we come now to 
the consideration of the therapeutic power and value of 
medicaments. It is presumed that we are already suffi- 
ciently prepared upon this subject to perceive, that no medic- 
ament possesses that kind of mysterious and indefinable 
property, which imagination assigns to a certain antidote or 
specific remedy. No well informed physician will believe 
that any chemical, vegetable, mineral, or animal substance, 
possesses a power, by which it can directly put to silence the 
morbid motions which constitute disease : restore to natural 
condition the morbid enlargement and indurations, which are 
consequent on many chronic affections : or change and re- 
store to a healthful state, the great volume of sickly fluids, 
rendered morbid by a long continuance of a disease of some 
one or more of the important secretory organs. None but 
empyrics, or the dupes of quackery, believe there is any such 
medicine. 

The most enlightened and skillful physicians are most 
ready to admit the uncertainty of the therapeutic effect of 
remedies. And it will be found that the most judicious are 
in the habit of employing the fewest number of articles, and 
those few in their simplest forms. When a practitioner of 
medicine shall have administered any one of the boasted 
medicaments and looked in vain for promised effect, until sick 
with disappointment ; when a discreet judge of the seat and 
power of any disease, and of all the complications which it 



MEDICAMENTS. 237 



may involve ; and one who knows in how many instances, 
cases are presented which are altogether unmanageable ; 
when any such capable physician, has for a long time, in 
reiterated instances, proved the inefficacy of supposed medic- 
aments, his good opinion of such uncertain articles must di- 
minish, and he will daily be engaged in lessening the cata- 
logue of his materia medica, and in simplifying his practice. 

It is now sufficiently understood, that any medicine makes 
its sensible impression on some important organ, generally 
exciting it to a more active performance of its particular 
function. And that the impression, although a proper one, 
may be nearly or altogether useless, by being too slight ; or it 
may be satisfactorily effectual, by being sufficiently decisive. 
In the administration of remedial agents, the medical philos- 
opher calculates on physiological effects to be produced, 
either locally or generally. There is nothing dark or mys- 
terious in his calculations. He knows the structure of the 
human body, he is satisfied as to the diseased organ, he 
knows the nature and power of the disease ; he knows more- 
over, what medicaments to employ. He foresees the neces- 
sity of certain changes in the condition of the diseased or- 
gan, and what agent is known by the profession, from expe- 
rience, to accomplish the intended effect. His calculation is 
therefore always simple, and readily tested. And if at any 
time, he may meet with difficulty, it is because he is not in- 
formed of the seat or nature of the disease, or he is not ac- 
quainted with the kind of impression which is necessary for 
its removal, or with the medicament which is suited to make 
that impression ; or else the disease is such as must fairly be 
considered incurable by any known remedy. 

If we admit the existence of a specific remedy; of a med- 
icament which possesses the power directly to destroy the 
disease for which it is the infallible antidote, we must admit, 
that it possesses sui generis a hidden principle, which lays 
hold on the organic structure of the part diseased, and 



238 MEDICAMENTS. 



compels it to return to its natural state — an absurdity, a folly, 
which has no place in science. If each medicament had 
claim to a specific power, then none would be effectual, ex- 
cept only in the particular affection for which it is specifically 
appropriate. But it is now known, that in many instances, 
the same kind of disease, and in similar circumstances, is 
cured by agents of opposite powers. Fevers produced by 
marsh effluvia, are cured by depletion ; they are also cured 
by the liberal use of the potent tonic agent, quinine. More- 
over if medicaments act by means of specific virtues, then of 
course, they ought always to be in some degree appropriate, 
in the respective cases in which they are the reputed anti- 
dotes ; that is, they ought infallibly to cure, or at least to 
diminish the violence of the disease. But how is the fact. 
Quinine which at one time corrects an intermittent fever, at 
other times increases the power of the disease, and instead of 
postponing, brings about a hurried anticipation of the parox- 
ysm and renders every symptom more alarming. A tonic, 
which always ought to produce an increase of strength and 
comfort, if at all ill-timed, will greatly increase debility, and 
if persisted in, destroy the patient. A pectoral preparation, 
well-timed and appropriate, facilitates the discharge of the 
mucus, by improving the condition of the exhaients, and like 
a charm soothes and relieves the patient. Administer the 
same remedy in a cough accompanying considerable pyrexia, 
and it will not only fail to give relief, but will greatly aggra- 
vate every inconvenient symptom. Hence it appears, that anti- 
spasmodics, tonics, diaphoretics, diuretics, and even emetics 
and cathartics, are able to produce each their proper effect, 
then only, when they are made appropriate, by the judgment 
and skill of the experienced workman in the profession. A 
classification of medicines, therefore, under these and similar 
heads, without much precaution, is calculated very seriously 
to mislead the young physician ; and indeed the same may 
be said of the whole volume of nosology. Tonics, febrifu- 



MEDICAMENTS. 239 



ges, aperients, and the like, are deceitful appellations, and 
have often led the inattentive far astray. The same has 
been done by the association of a specific remedy, with the 
name of a disease. An intermittent or remittent bilious fever 
is announced, and the principal remedy is quinine. A syph- 
ilis is announced, and the remedy is mercury. But the dis- 
cretions which we have had under our consideration, have 
taught us that, easy as this association of the name of the 
disease and its supposed appropriate remedy seems to be, it 
will require much skill and attention, to make a proper use 
of either of the articles, specified in the cases referred to. 

The organs essential to life exhibit impressions of motion 
or action corresponding to the expressions made on them by 
the medicaments employed in view of affecting their condi- 
tion, respectively. The motion or action thus artificially ex- 
cited, will be either in concert with, or in opposition to the 
motions and actions produced or maintained by the injury or 
morbid condition of the organ concerned, which the artificial 
action of course is intended to diminish and remove. The 
excess of natural action is to be put down by extinguishing 
a portion of vitality, or removing some irritating agent, or 
wearing down the mobility by exciting and maintaining an 
action stronger than the natural action, till the irritated ves- 
sels shall have become sufficiently tired to take rest and re- 
turn to order. 

A sick stomach is often cured by vomiting, a diarrhoea by 
a cathartic ; an intermittent fever by maintaining uniform 
excitement through the tonic power of quinine, and an erysipe- 
las by the proper application of external heat. A sick stomach 
under other circumstances is relieved by the use of opium 
and carminative drinks, as clove tea, &c. A diarrhoea, under 
similar circumstances, is likewise arrested by appropriate do- 
ses of opium ; by astringent and cordial drinks, and by in- 
jections. An intermittent fever by keeping the patient in 
bed, and excluding light, and sometimes by the exhibition 



240 MEDICAMENTS. 



of a portion of spider's web. And erysipelas, in the form of 
shingles, will retire on the eighth day, under the application 
of dry meal or black cat's blood; that is, it will retire spon- 
taneously. Apparently the same disease is removed by the 
use of stimulants of sufficient power, or by a copious blood- 
letting, the most opposite practice that could possibly be 
adopted. 

Note by Dr. Snyder. — u Medicinal substances are those 
bodies which by due administration, are capable of producing 
certain changes in the condition of the living system, where- 
by its morbid actions may be entirely removed, or advanta- 
geously controlled." This definition excludes aliments. 
Medicines are relative agents : Sir Gilbert Blane, states, that 
" The virtues of medicines cannot be fairly assayed, nor ben- 
eficially ascertained by^trying their effects on sound subjects; 
because that particular morbid condition does not exist which 
they may be exclusively calculated to remove. An instance 
occurs in tonics, which are felt in debility, but whose effects 
are not noticeable, or wholly inappreciable in a robust condi- 
tion of the body. 

The effect of a remedy may depend upon mechanical, 
chemical, or vital agencies. They may be absolute or rela- 
tive ; primary or secondary. ; local or general ; direct or sym- 
pathetic ; permanent or transient. Some purges are nearly 
absolute, as elaterium. Diuretics depend on a certain con- 
dition of the body, therefore are considered relative, &c. 



ETC. 241 



CHAPTER III. 



OF THE SURFACES TO WHICH MEDICAMENTS MAY BE 

APPLIED, AND THROUGH WHICH, IMPRESSIONS 

MAY BE MADE BY MEDICAL AGENTS. 



Some intimations have been given respecting the surfaces 
to which the therapeutist may make the application of his 
medicaments. There are, however, no more than two upon 
which we can generally rely. The one is the skin, that is 
the whole cuticular surface of the body. The other is the 
mucous membrane, that is the inner surface of the stomach 
and lower intestines, the schneiderian membrane, the tongue, 
fauces, urethra, &c. 

In making our selection of the surface on which we shall 
attempt to operate, it is necessary that we consider the effect 
we wish to produce, the state of the several organs or surfaces 
which are to be the subjects of our choice, and the probable 
duration of the treatment, which the case will require. 

If the intention be to use an irritating agent, and which is 
to be continued a long time ; as is frequently the case in the 
employment of mercurial remedies ; when much stress is laid 
on the absorption of the article, and especially if the stomach 
and lower intestines are easily disturbed by its agency, we 
should prefer an application to the cuticular surface, or to 
those parts of the mucous membrane, which are less disposed 
to involve a serious effect on the peristaltic action of the 
bowels. This method is often employed in the cure of syph- 
ilis. So the muriate of gold is applied by friction to the 
tongue. In this way, the effect of the remedy is secured at 
the same time that the alimentary canal is protected. But 
16 



'242 OF THE SURFACES. ETC. 

the stomach and intestines, by reason of their peculiar sus- 
ceptibility of any intended impression, and of the great power 
of absorption with which they are endowed, present the 
surest channel for conveying into the system, any ordinary 
medicine : and therefore physicians generally, have their 
chief reliance on these, in their therapeutic opera.tions. The 
great point is, to be prepared to make our application in a 
manner, which shall accord with the degree of vitality pres- 
ent, in every case. To be sufficiently decisive without ex- 
tinguishing the powers on which our therapeutic intention is 
dependent for success — remembering, that if rightly and de- 
cisively administered, potent agents are truly medicaments ; 
if with timidity, and in too small portions, they are no better 
than inert substances : and if in portions too strong, they are 
poisons. 

When the stomach is too irritable to admit the use of some 
important article, the rectum presents a surface, which is 
capable of a very active absorption. It can be excited, too. 
in a manner to produce powerful revulsive motion, even tar- 
tarized antimon}^ will in some instances produce its emetic 
effect, more agreeably when employed as an enema, than 
when taken into the stomach : especially so in cases of 
young children. In some of the hospitals of France and 
Great Britain, fumigations of mercury and other agents have 
been applied to the lungs, it is said not without benefit. It 
would seem probable, that this practice might be improved, 
and that the time will come, when vapors of suitable powers 
will be inhaled with certain benefit to the patient. 

The mucous membrane of the vagina, or of the urethra, 
the eustachian tube, the inner surface of the ear. the con- 
junctiva of the eye, are scarcely ever subjected to the appli- 
cation of medical agents, except only in the instances when 
any one of them is treated for some disease of which it is 
itself the seat, and nearly all such cases belong to the de- 
partment of surgery. 



243 

In speaking of medical applications to be made to the skin, 
we must call attention to the fact, that some are more effec- 
tual when applied to the reticular surface, when it has been 
stripped of the epidermis. The cellular and vascular expo- 
sure of wounds, present surfaces which perform very active 
absorption, and any action excited in them, is very speedily 
propagated and extended over the whole organic structure.* 
Vaccination acts in conformity with this law. Mercurial 
applications made in this way, in a short time produce sali- 
vation and cure syphilis. The same agent applied to chan- 
cres and buboes afford strong evidence in support of the fact. 
Arsenic applied to ulcers having been absorbed has produced 
death. Cantharides applied for the purpose of blistering, 
have irritated the neck of the bladder to serious inflamma- 
tion. Messrs. Chiarenti, Alibert, Pinel, Dumeril, Brera and 
others, have multiplied experiments in this way, and through 
cutaneous friction, have produced the proper effect of cathar- 
tics and diuretics ; also the tonic and febrifuge effect of quinine 
and other therapeutic agents. Messrs. Lambert and Leseiur, 
have in like manner introduced almost all the articles of im- 
portance which are known to be taken up by absorption. 
Substances employed in this way, have been denominated 
by the French physicians as emplastro-clermique. Such arti- 
cles ought to admit of great concentration of power in a small 
compass. When known to be very irritating, they are in- 
corporated with cerate or gelatin. If they have a tendency 

* Dr. A. J. Wedderburn has reported in the New Orleans Medical and 
Surgical Journal, (January No. 1846,) several cases in which the sulphate of 
quinine applied freely in substance, to the surfaces of ill-conditioned and 
indolent ulcers produced the most speedy and salutary changes. 

We have applied the sulphate of morphia to the abraded surface which had 
been previously blistered, for the correction of the most alarming and pain- 
ful condition of the abdominal viscera, with the most decisive and beneficial 
effects. From one to three grains was sprinkled over a surface of from four 
to six inches square. The effect is the same whether we use the sulphate 
or acetate of morphia. The article in such cases should be ground up with 
a little loaf sugar and gum arabic. 



244 OF THE SURFACES, ETC. 

to cicatrize or heal easily, they are united with epispastic 
pomatum. With the acetate of morphine, they have cor- 
rected the distressing watchfulness which often afflicts the 
sick, particularly nervous patients ; eased the racking pains 
of patients in chronic rheumatism, and relieved or cured ob- 
stinate pulmonary catarrh. By the application of sulphate of 
quinine, intermittent fevers, tertians and quartans, have been 
cured, after having been long treated in vain with cinchona 
and quinine in the usual way. A very distressing neuralgia, 
accompanied with symptoms of hysteria, was cured with the 
greatest ease and expedition, by the external application of 
acetate of morphine mingled with assafcetida. A case of 
tetanus produced by the application of nux vomica to an ex- 
coriated blister, was instantly relieved by the acetate of mor- 
phine. This fact would justify a hope of our being able by 
this method, to cure tetanic affections. Musk, digitalis, 
chrystals of acetate of lead, applied to vesicated surfaces, 
have relieved diseases of the heart, pulmonary congestions, 
and affections partaking of the nature of asthma. 

In quoting these instances noticed by modern French au- 
thors, it should be remembered, that in making the remedial 
application, an issue, or what is equivalent to an issue, is es- 
tablished at the outset, and as the treatment is to be contin- 
ued a sufficient length of time for effecting recovery, it is 
not improbable that the sympathetic irritation may be entitled 
to a goodly share of the credit which is given to the quinine, 
acetate of morphia, musk, digitalis, &c. 

We have no intention, however, to detract from the merits 
of this kind of practice. W r e hope it will be continued, and 
reiterated under the necessary observation, until it shall be 
satisfactorily understood, how far credit is to be given to 
absorption, and how far to irritation merely. The introduc- 
tion of medicaments into the veins is out of the question, 
except for incorrigible mania, tetanus, &c. 

Therapeutic agents probably make an impression which 



OF THE SURFACES, ETC. 245 

has a tendency to change the condition of the tissues, as well 
as to modify the action of the organs. It is desirable to as- 
certain the changes which take place in both the solids and 
fluids of the system, when affec&ed with disease. As yet, 
however, much remains to be Abne. When and in what 
manner medicaments produce changes in the constituent ma- 
terials, which form lymph, or blood, is an inquiry of great 
difficulty. It is equally difficult to ascertain, how far the 
therapeutic effect may depend on such changes. The old 
doctrines, which proposed to render the blood thick or thin, 
or sweet or more acid, or alkalescent, are now all exploded, 
and modern science has not left us a substitute. The re- 
ceived opinion is, that medicines act on the living organs, 
after the manner of ordinary or natural stimuli. Under their 
influence vital actions return to their natural state, the con- 
stituent principles of the fluids are duly elaborated, the solids 
are refitted, so that the several tissues develop themselves 
and perform their functions with suitable activity; and the 
most we know with certainty is, that these changes are con- 
sequent on the impression made by therapeutic agents upon, 
the living organs. And although particles of the medicinal, 
substances which may have been employed, have been de- 
tected in the blood, bile, lymph, urine, or other recrementi- 
tious and excretory fluids ; it affords no satisfactory evidence, 
that the good effect produced by the remedy, depended ma- 
terially, if at all, upon this apparent combination of the med- 
icine with those fluids. Such appearances are worthy of no- 
tice, however, and sufficient acumen and observation may 
one day turn them to account. There can be but little 
doubt entertained, that the agency of medicaments is felt by 
the tissues, whose condition can be usefully affected by any 
appropriate agent. The skin under the influence of proper 
remedies, can be made to take on its white, smooth and even 
surface, after it has been covered with pustules or scabs, or 



246 

thickened to an unnatural degree. The muscles after hav- 
ing been lank, languid and devoid of strength, become full, 
firm and strong, under the use of suitable medicines. Mem- 
branes which have been relaxed or rigid, are restored to their 
proper condition and to the performance of their regular 
functions ; even bone, which has been softened by a disposi- 
tion to scrofula and rachitis, has been made to recover its 
proper degree of firmness and solidity. Inflammation, con- 
gestion, or sanguineous engorgement, unnatural growth or 
enlargement of parts, all, are made to retire or at least to 
abate their progress, under the influence of well conducted 
medical treatment. 

The therapeutist can effect an increase or abatement or a 
regulation of the functions. Digestion, absorption, secretion, 
circulation, respiration, sensorial energy, even nutrition, are 
all, more or less subject to his discretion. An increase of 
the functions may be produced directly in cases of debility, 
by the employment of appropriate cordials and stimulant 
means. But when they become languid by reason of too 
much fullness, which is the case in most instances of fever, 
the same object is to be accomplished by opposite means, in 
an indirect way — say, by depletion, and perhaps it may be- 
come necessary to call to our aid, the means which promote 
an increase of secretion. Functions when performed in a 
morbid way to excess, are made to abate also by similar ap- 
plications of direct or indirect means, and their regulation in 
general, is accomplished by the employment of either stimu- 
lant or evacuant medicines, as the case may require. These 
remarks are intended to be considered in view of disease of 
recent date and of short standing ; in almost all of which, it 
will be found on experience, that they are perfectly appropri- 
ate and include all that will claim attention in respect of the 
general treatment. But the functions are often put out of 
condition, by organic diseases of long standing, and in all 



OF THE SURFACES, ETC. 24" 

such cases, the employment of the means, just now men- 
tioned, will be altogether unavailing, except so far only, as 
every one of them may at any time become a constituent part 
of a plan, instituted for the purpose of removing such organic 
injury. 

Organic disease, if not removed on its first attack, and of 
course if permitted to assume a chronic form, has a constant 
tendency not only to alter the particular organ which is the 
immediate seat of it, but eventually to throw the whole sys- 
tem of organs into disarray. In such cases the physician 
will find it necessary to proceed with great circumspection 
and judgment j without which there can be no hope of suc- 
cess. He must be prepared to investigate, nay, as if to pen- 
etrate the condition of the organic structure, in order to as- 
certain where the original seat of the disease is, to know the 
progress with which it has entangled other organs, and deter- 
mine upon which of those to commence his operations. 
Irritations must be diminished or diverted away from the 
points on which they have been habitually fixed ; associa- 
tions of motions or irritations must be dissolved, morbid de- 
terminations must be called back to the channels from which 
they may have wandered, the nutritive functions must be 
guarded and modified, and such general arrangements made. 
as may bid fairest to promote the accomplishment of the lead- 
ing intention, which is kept in view. This part of our prac- 
tice always requires time. The disease may have been 
months or years in establishing itself; it cannot be recover- 
ed in a day. Such cases will call into use all the medical 
science we can collect, and will give employment for our 
utmost ingenuity. We must devise suitable aliments, such 
as will support the patient without aggravating the disease, 
and we must preserve animation whilst in the use of articles 
inevitably more or less deleterious. 

The ancients, on observing that diseases were in many ca- 



248 

ses complicated, with intention to meet them under all cir- 
cumstances, introduced the use of compound medicines, so 
that, let the disease be howsoever occult, some one of the 
ingredients might, by chance, be its antidote. In avoiding 
this ridiculous error, we must be careful not to run into the 
opposite extreme. We may find it necessary to turn atten- 
tion to more than one organ at once. A person laboring un- 
der the distress of a chronic hepatitis, may by some casualty 
be subjected to an inflammation of the lungs, to an attack of 
enteritis, or an inflammatory rheumatism. In any such in- 
stance of complication of disease, we attend first to the symp- 
toms which are most painful or dangerous. Inflammation of 
the lungs, enteritis and inflammatory rheumatism, require 
blood-letting. But as the liver is diseased, it will be neces- 
sary to modify the practice with a suitable reference to the 
condition of that viscus. That is, more catharsis will be re- 
quired, more time, and more careful attention to the conva- 
lescence, and after all other symptoms shall have retired, it 
will be particularly important to review the state of the 
viscus which was previously affected. Something like this 
should be the management in all cases of complicated affec- 
tions. 

It is now asserted by many physicians, that all medica- 
ments are either stimulants or sedatives : acting generally, on 
particular organs, ^according to the principles above stated. 
Our experience has led us to believe, that all medicines, from 
whichever of the natural kingdoms selected, do act primari- 
ly as excitants, making their impression first on the part with 
which they come into contact, and extending an influence, 
which, according to the phenomena that follow, has served 
to distinguish their therapeutic characters and merits. And 
that most, if not all, might be used in such a way, as 
indirectly to act as sedatives. Of course we can come to no 
other conclusion but this, that there is no medicine which 



249 

is directly sedative, although opium judiciously administer- 
ed when necessary, admits of being used with that intention, 
with speedy success. 

At the same time that all medicines are really excitants, 
the experience of every day proves, that on the use of some 
particular articles, certain particular organs and tissues give 
evidence of their particular excitement, and that under suita- 
ble circumstances, the same results pretty uniformly follow 
their use ; as if an impression were made analagous to that 
which attends upon the insertion of the vacine pus, or that of 
the variola, or that which follows the touch of the syphilitic 
matter, or the influence of the effluvia which is disengaged 
from the bodies of persons afflicted with variola or rubeola. 
So it appears that sulphur affects the skin of all who use it ; 
antimonial pomatum, or cerate, produces an eruption which 
is similar in all cases in which it is applied. Digitalis is 
thought in all cases to reduce the action of the heart ; nar- 
cotics produce nearly the same effects in all similar instances 
on the nervous system ; nitrate of potash on the kidneys ; 
iodine upon the lymphatics ; and mercury upon the liver 
and its appendages, and upon the salivary glands. 

That these articles, as well as all others, first act on the 
general system, before they affect the organs which are lia- 
ble to be permanently excited, is an important consideration. 
It is often the case, that the general action of the. system is 
such, that the first impression made by any one of them, has 
a tendency to defeat the object which is contemplated as the 
ultimate intention. Digitalis, for example, if administered 
in a case of pulmonary inflammation, will be found altogeth- 
er inappropriate. Yet the same article in a chronic affection 
of the lungs, consequent on having relied on insufficient 
blood-letting, sometimes acts most effectually. Digitalis, 
then, excites too much on general principles, to be appropri- 
ate in cases of great recent inflammation. But when there 



250 

remains some effects of congestion in the capillary vessels, 
which keep up irritation, the excitement given to the system 
generally by the digitalis, seems to convey additional energy 
to the capillary absorbent vessels, and make an impression on 
the heart, which, for a considerable length of time, in a very 
peculiar manner, renders it less irritable to the touch of the 
blood, which it is compelled to admit at every diastole. Our 
conjecture here may possibly be incorrect, but we have sev- 
eral times used digitalis without effect, and judging that the 
excitement in each instance was too strong, we have let blood, 
and immediately found our expectations realized. Every 
man of experience in the practice has found cases in which 
the general action of the system was too great, or its suscep- 
tibility of being excited too acute, to acknowledge the power 
of mercury, even as a cathartic, and very often as a sialagogue 
or general alterative. This is so common that it is now a 
settled rule, that in almost all cases, the use of the article 
ought to be preceded by sufficient blood-letting. The same 
may be said of antimony as a diaphoretic : of nitrate of po- 
tassa as a diuretic, and even of jalap and calomel as cathar- 
tics. That there is some peculiarity of impression made by 
each particular agent, which is inseparable from its touch 
when introduced into the system, is a truth as certain as that 
the effect is a general one. For this is proved by the uni- 
formity of the particular phenomena which follow the use of 
each. And in fact, we are inclined to believe, that the gene- 
ral impression would appear to observation, to be identi- 
cal throughout the system, if every organ were prepared to 
make report. Hence it is, that in frequent instances, when 
emesis is expected, we are met with catharsis, and vice-versa 
with both, when one only is desired. And it is from this 
cause, that we sometimes find it impracticable to procure the 
particular effect at all. Nothing is better known to the prac- 
tice, than that very often a desire to procure a salivation is 



251 

defeated by an incorrigible tendency of hydrargyria to act 
on the bowels. This fact calls to mind another considera- 
tion, the reverse of that just now disposed of ; which is, that 
as all medicines first make an impression which enforces a 
general action sni generis, before the particular action can be 
exhibited, which is only consequent on the general action, 
therefore, it is as indispensable that the powers of the system 
should be able to sustain the general action in this last men- 
tioned instance, as that they should be reduced down to 
an appropriate standard, when too high to consent with 
the peculiarity of impression which it is intended to make. 

These remarks in some sort explain the obscure and mys- 
terious subject of specific action. Whatever kind of an im- 
pression is made by any article of the materia medica, it is 
felt by the whole system, but by some one organ more par- 
ticularly and for a longer time. This is the whole account 
of specific action. 

In further confirmation of the correctness of this viw, we 
add, that syphilis can be cured w'ithout mercrlry, cinchona 
can be substituted by a great variety of stimulating articles, 
in the cure of intermittents ; tetters, ringworm and itch are 
cured without sulphur, and except vaccination for preventing 
variola, there is almost no remedy which cannot be substituted 
by some other, in almost any case ; which proves unequivo- 
cally, that there can be no absolutely specific action, according 
to the general acceptation of that word. Again, as our medi- 
cal agents are all excitants, with greater or less power, and 
have a tendency to determine the sympathies of the system, 
one to this organ, another to that, it is within the ability of 
the therapeutist to divert those sympathies when determined 
by disease upon any particular organ, to some other, so as to 
produce what is called a revulsion. In this way, in the com- 
mencement of an attack of sickness, a decisive emetic or ca- 
thartic, is followed by a complete restoration to health ; but 



252 OF THE SURFACES, ETC. 

if the operation of either be too light to accord with this 
view of revulsion, it will generally be ineffectual. A sore 
ptyalism will serve to cure some species of head-ache, by the 
same law, or a reiterated irritation of the primae viae with 
light doses of calomel and ipecacuanha, will cure a dysentery 
in some of its forms. 

It appears very clearly, that the therapeutist must know 
the character and power of the articles he is to use in his 
profession, the general action, and the effect of that action 
on the general system ; the particular action and the state 
of the general system, required to be present, in order that 
the particular action may be properly and usefully de- 
veloped. 

It was remarked above, that more than one organ is some- 
times diseased at the same time, and of course that our prac- 
tice must be modified in reference to each of the affected or- 
gans ; and our remarks in part went to show, that different 
agents might be employed at the same time, having in view, 
in the use 00 each, the particular affection to which it is 
known to be applicable. Experience justifies this : for we 
are in the habit of administering in the form of pill, bolus and 
tincture, two or more articles, with the intention to meet 
complicated cases. Such compound medicines, however, 
are chargeable with empiricism, in all cases in which the 
therapeutist is not prepared with satisfactory certainty, to 
know that the combination is not incompatible with the laAvs 
of chemical affinity ; and in the next place, that the effect of 
either on the general system, will not render it unfit to re- 
ceive the impression intended to be made by the other : that 
there is no contrariety in the action produced by one, to the 
action intended to be produced by the other ; that the con- 
dition of the patient is such, that the agency of each may be 
safely accomplished at the same time, and that either expe- 
rience, or a very rational and satisfactory analogy affords 



i 



OF THE SURFACES, ETC. 253 

proof, or properly justifies the expectation, that such a com- 
position may be used in such cases, with safety at least, not 
to say certain advantage. But after these remarks, it is pro- 
per to add, that a sufficient acquaintance with chemistry, 
with anatomy, physiology, pathology and therapeutics, will 
always justify a discreet use of such combinations of agents ; 
and in cases of great difficulty, when known remedies judi- 
ciously administered fail, to make trial of other agents ; such 
as analogy would suggest; and have recourse to other combi- 
nations, predicated on the accomplishment of other revulsions 
or irritations. 



254 EMETICS. 



CHAPTER IF. 

EMETICS. 

'•' An emetic is a substance which excites vomiting by a 
specific impression on the stomach,. independent of mere dis- 
tension from quantity, or of nauseous taste or smell." This 
definition admits of no difference of opinion. But as to the 
modus operandi, or the mechanism of vomiting, physiologists 
are not so well agreed. Experiments have been made, ap- 
parently with great and equal fairness, which have led to 
very different conclusions. Some have served to prove, that 
in the act of vomiting, the stomach is quiescent, and that its 
contents are ejected by being forcibly compressed, between 
the diaphragm and abdominal muscles. Others, that vomit- 
ing is effected entirely by the contraction of the muscular 
coat of the stomach — and many now entertain this opinion 
concerning it. But if we have made correct observation, 
there is a co-operation of the abdominal muscles and dia- 
phragm, together with an inversion of the peristaltic action 
of the stomach, in producing emesis. If we inquire how 
emetics excite these actions of the stomach and muscles, so 
as to perform the effort of vomiting, we are compelled to ad- 
mit that we do not know. Forty years ago, on reading Dr. 
Darwin's speculations on the subject, we considered them 
very specious. He supposed, that when nausea is produced, 
not the stomach only, but the whole system is in a state of 
temporary debility ; as the nausea increases, the natural pow- 
ers of the stomach are more and more diminished, until they 
entirely cease, and then give rise to an inverted motion of 



EMETICS. 255 



its muscular fibres. This view, he thought, was confirmed 
by the fact, that debility produced by blood-letting to syncope 
or by concussion of the brain, is almost uniformly followed 
by vomiting. All this is fanciful, being a statement of the 
appearances as they occur, with his supposition respecting 
the causes of those phenomena, and nothing more. When 
we introduce an agent intended to produce a certain effect, a 
train of events is exhibited, by the observation of which we 
arrive at an approximation to the knowledge of the general 
character, and the order of those events ; and this is nearly 
the amount of our knowledge of the modus operandi of our 
remedy. Dr. Eberle, in making a. statement of his views, 
says, " The emetic, in the first place, makes an impression 
on the sentient extremities of the nerves of the stomach. 
This impression is immediately referred to the sensorium 
commune, in consequence of which, its natural energies are 
diminished, as is evinced by the langour of both the intel- 
lectual and corporeal powers. But as the sensation of an ir- 
ritated organ, depends in reality, on a peculiar excitement in 
the sensorium commune, so we may infer, that the sensation 
of nausea, is the immediate and necessary result of the di- 
minished and peculiar cerebral excitement referred to the 
stomach. That is, in fact, the case is demonstrated by the 
vomiting and nausea, which are sometimes excited by the 
sight, smell, taste, or even thought, of a disgusting object." 
Here, however, the Doctor admits our progress is arrested, and 
this is, in fact, Darwin's definition, with no more than a 
mere change of phraseology. The simplest statement imagi- 
nable would explain the invisible agency, full as well as 
Darwin, Cullen, Chapman, Eberle, or the entire host of phy- 
siologists. For when it is said, that certain substances are 
peculiarly offensive to the stomach, that by a law of the ani- 
mal economy, when any such substance is introduced into 
that organ, an effort is made to eject it by the act of vomit- 
ing — that like all other animal functions, the process is re- 



256 EMETICS. 



ferrible to the sensorium under whose influence, in a way in- 
explicable, it is performed — all is said that is known on the 
subject. However, we cannot regret our having inquired, 
how far the subject admits of explanation : especially as we 
have learned something useful by the excursion. We have 
learned, that an emetic produces temporary debility, that the 
state of the system in emesis, is analagous to that whtch im- 
mediately follows a decisive blood-letting ; and that in pro- 
ducing this effect, it checks immediately upon the sensorium 
commune. For these facts, we may find an important use 
in the sequel. 

When an emetic is taken, its first effect is, an uneasy sen- 
sation at the stomach, which gradually increases up to a 
sense of nausea. In the mean time the pulse becomes fee- 
ble frequent and irregular ; the face turns pale, a general 
coldness pervades the surface, and the skin displays the cutis 
anserina. Presently the vomiting commences, when the 
face suddenly becomes flushed, the capillaries being well fill- 
ed with blood ; and at last a temporary diaphoresis is produc- 
ed. So soon as the vomiting ceases, the sickness retires, 
giving the patient an agreeable respite, during which the sys- 
tem recovers from the langour consequent on the effort of 
vomiting. This great effort, and the consequent langour, 
constitute the principal importance of an emetic. 

In the first instance, the effort evacuates the stomach. 
But the pressure made by the abdominal muscles very often 
causes the contents of the duodenum to regurgitate into the 
siomach, so that- bile is copiously discharged. Hence we 
infer, that the liver and gall bladder, must likewise be con- 
siderably compressed between the abdominal muscles and 
the diaphragm, which produces a more copious discharge of 
bile into the duodenum. The previous nausea induces a de- 
gree of relaxation in the ductus communis, which circum- 
stance is favorable to that process. The appearances of the 
matter which is discharged by vomiting, confirm this ac- 



EMETICS. 25/ 



count. During the first efforts, very little bile is thrown up: 
but by the abdominal pressure and agitation, the biliary ducts 
and gall bladder are emulged, their contents thrown into the 
duodenum, and the subsequent and more intense strainings 
pass them into the stomach, when by vomiting they are at 
length discharged. In cholera we observe the same thing, 
since no bile is discharged, until vomiting has continued some 
time. We may then infer, that vomiting acts powerfully on 
the nervous system — evacuates the stomach — emulges the 
vesse]s of the liver, and by the great agitation and pressure 
made by the effort, upon the whole of the abdominal viscera, 
has a tendency to produce important changes in the condition 
of all the vessels, pertaining to the portal circle. Their ef- 
fect upon the sensorium is powerfully and happily displayed 
by administering them after blood-letting in the commence- 
ment of pleurisies and other highly inflammatory affections. 
The venerable Mr. Finley of Pennsylvania, so long known 
as a distinguished member of Congress, informed us, that he 
ordinarily prescribed for some of hi3 poor sick neighbors, and 
that it was his practice, first to bleed freely, and immediately 
afterwards to administer a decisive emetic* His success 
was great, and the practice is worthy of imitation. 

In our elementary observations we stated that after blood- 
letting, for a certain length of time, there follows an accumu- 
lation of sensorial influence. This influence when accumu- 
lated, will invariably direct itself upon the structure which , 
may be in a condition of irritation. Hence it is, that when a 
very acute pain, such as occurs in pleurisies, may be appa- 
rently relieved by a decisive use of the lancet, unless measures 
be taken to prevent the accumulation referred to, when the 
system shall react, the pain will return with a degree of vio- 
lence, in some instances as distressing, as it was at the first. 
A decisive emetic lessens or prevents this inconvenience ; iS 

* By this practice hemorrhagic reaction was properly regulated,. 
17 



258 EMETICS. 



administered immediately after the depletion. A counter im- 
pression is made on the stomach by this practice, by which 
the accumulating sensorial influence is used up as it rises. 

If it can be ascertained that a stitch in the side is really at- 
tributable to an inflammation of the pleura, without any com- 
plication of the parenchyma of the lungs, the employment of 
a large dose of opium and calomel, will more effectually se- 
cure the same result. So also in a case of peritonitis with- 
out complication, if we bleed to fainting, and follow the use 
of the lancet with a similar dose of opium and calomel, the 
effect will be most comfortable. 

An emetic may follow the blood-letting without hazard? 
and generally with great benefit. Very frequently a large 
sinapism or epispastic is greatly beneficial, for the same pur- 
pose. To meet the intention properly, the mustard ought 
to be applied fifteen or twenty minutes in anticipation of the 
intended depletion. By this last precaution, employment is 
given to the accumulating sensorial influence, and the action 
of the capillaries of the skin is simultaneously secured. 

Hemorrhagic reaction, which is the effect of an accumula- 
tion of sensorial influence, ought generally to be prevented by 
similar means, whether the depletion which is the cause of 
it shall have been intentional or accidental. 

It is a common practice in treating a case of pulmonitis, to 
let blood freely, and during the interval between the exacer- 
bations, to make a liberal use of antimonials. This method 
in some degree accomplishes the same intention. But the 
subject rightly understood, will eventually lead every man 
of skill, to the employment of measures which will effectual- 
ly regulate the sensorial influence, and maintain a continu- 
ous action of the capillaries of the skin. Until something 
less offensive shall be discovered, an emetic will merit special 
attention, as one of the most valuable agents for the accom- 
plishment of this important end. Permit us to insert in this 



EMETICS. 259 



place a few memoranda, which may be found useful to the 
practitioner of medicine. 

Emetics lose nothing of their power by repetition ; on the 
contrary, the stomach becomes more susceptible to their im- 
pression by their frequent use. Vomiting may be made sub- 
ject to volition, by habitual attempts to excite it. Dr. Cullen 
mentions an instance in which, by frequent practice, one- 
twentieth part of a grain of tartarized antimony was an ef- 
fectual dose. 

In some instances of protracted fever, an ordinary portion 
of tartar emetic or ipecacuanha will fail to produce emesis ; 
and if the dose be enlarged, it will produce hypercatharsis. 
This is an important fact, inasmuch as the intention impru- 
dently pressed, might produce fatal effects in one day. Again 
the system may be in a state the reverse of this, and an eme- 
tic be ineffectual, till the sensorium is released by blood-let- 
ting. 

By violent and repeated retchings, jaundice is sometimes 
induced. The liver and gall bladder are, in that case, too 
much pressed, and the bile regurgitating, is carried into the 
vena cava. According to Haller's experiments, an injection 
thrown into the hepatic duct, will escape by the hepatic 
veins ; this is also confirmed by the experiments of Saund- 
ers, who found that water injected in the same direction, will 
return by the veins in a full stream, though very little force 
be used. This kind of jaundice needs no interference, as the 
bile will be eliminated by the kidneys in a very few days. 

Severe vomiting should commonly be avoided in the ad- 
vanced states of pregnancy, in hernia, and in prolapsus uteri. 

Emetics are advantageously employed in such diseases as 
are attendant on persons whose abdominal organs are in a 
sluggish state. In all such instances, however, blood-letting, 
and other appropriate evacuations, must precede the use of 
the emetic, especially, when there is a tense pulse and acute 
pain. 



260 EMETICS. 

Effused fluids are sometimes rapidly absorbed under the 
influence of an emetic. This has led to the supposition, that 
emetics increase absorption. But the same result would fol- 
low, if they produce a diminution of the power of the exha- 
lents. And as blood-letting well timed and repeated, will 
produce the same effect; as the use of nitrate of potash, &c. 
sometimes affords relief in a similar manner; therefore we 
may infer, that emetics are useful in dropsies because they 
make a favorable impression on the nervous system. 

Experience has established the value of emetics in diseases 
of the brain. They are useful in asthenic mania, blood-let- 
ting having been premised. They restore calmness to the 
action of the vessels of the head, which in such cases is par- 
ticularly desirable. They are also especially beneficial in 
melancholic mania, in which it is supposed the brain is lan- 
guid, in consequence of imperfect sanguification. In hypo- 
chondriasis physicians generally believe, that some chronic 
visceral affection must lie at the root of the evil, and it is 
very probable that the good effect of emetics in such cases, 
are consequent on the impression made by them on the sto- 
mach and liver, by which the condition of the portal circula- 
tion is improved. 

Emetics are used extensively and with great advantage, in 
almost every form of fever. If administered in the forming 
stage, they often arrest its progress. " Antimonial emetics," 
Dr. Armstrong says, " have been very generally recommend- 
ed in typhus fever, and according to our observation, are ser- 
viceable when the fever takes on a complicated form, com- 
monly producing an improvement in the condition of the 
skin, respiration and pulse : and perhaps, it is on the power 
which they possess of determining the blood to the surface, 
and of changing the morbid states of the circulation, that 
their efficacy depends." 

In pneumonia typhoides, emetics will be found almost in- 
variably of great service. Taking care however, in this as 



I 



EMETICS. 261 



well as in any other affection, to prepare the system, if ne- 
cessary, by previous blood-letting. In this disease the re- 
medy may be administered under circumstances and appear- 
ances, which would forbid it in other affections. In cases in 
which there are much distress and pain in the chest, and 
even when the ordinary signs of congestion are present, emet- 
ics may be fearlessly administered, and they will be found 
to promote expectoration. 

Fifty years ago, in treating bilious fevers, the first prescrip- 
tion was an emetic ; this was followed by a cathartic, the 
practice to be repeated once or oftenerj then the effervescing 
draught was to be administered, till the type of the fever could 
be sufficiently developed. If remittent or intermittent in its 
form, it was encountered with a sufficient quantity of bark 3 
&c. All this was regular empyricism ; and yet it was often 
successful. Dr. Sydenham taught the necessity of setting 
out with one moderate blood-letting, and the practice after- 
wards partook of a similar cast. As bilious or intermittent 
fever occurs in this country, almost every case will receive 
benefit from an emetic, once or twice repeated ; but many 
will need previous blood-letting. Perhaps it ought to be ad- 
mitted, since it is the_ opinion of many good physicians, that 
emetics prepare the stomach to be more susceptible of the im- 
pression of other articles ; and consequently give them a full 
opportunity to display all their powers. 

In eruptive fevers, (exanthemata) emetics are often indis- 
pensible. This is the fact in scarlatina anginosa s but most 
of all, in its malignant form. In these affections, Dr. Arm- 
strong says, " When emetics are aided by the warm bath, 
they tend to free the system from the pressure of the pletho- 
ra of the internal bloodvessels, so frequently observed in the 
commencement of this disease, and by thus equalizing the 
whole circulation, to render the future case, most commonly, 
mild and manageable." 

Dr. Smith, in his record of cases admitted into the fever 



262 EMETICS. 



hospital of London, lets us know, that he let blood decisively 
in treating scarlatina ; we refer particularly to cases XXVIII 
and LVI. The first was bled sixteen ounces on the third 
day, the last sixteen ounces twice on the fifth day : they 
both terminated fatally. If perchance this work should meet 
his eye, we would call his attention to a few facts, for the 
establishment of which he has himself done much. He 
holds, that scarlet fever in every other circumstance but that 
pertaining to the eruption peculiar to it, commences and pro- 
gresses like idiopathic fever ; the train of events and the or- 
der of the train being the same. The sensorial structures, 
the thoracic viscera and the viscera of the abdomen, are all 
liable to the injuries common to fever. It differs from other 
fevers, by no specific mark, but that of the eruption. If 
therefore, we can have opportunity to bleed in anticipation 
of the establishment of the fever, it may be done with decis- 
ion, and invariably with good effect. If this advantage be 
lost, and the fever be permitted to establish itself, more mis- 
chief may be apprehended from ill-timed depletion in a case 
of scarlatina, than in fever with the same apparent degree of 
severity in the ordinary form. Eruptive fevers, in the de- 
gree of their intensity, invariably present with other symp- 
toms, great frequency of the pulse. According to our expe- 
riment made by external heat, as stated in chapter third of 
our elements, great excitement of the skin checks heavily on 
the existing stock of sensorial influence. If therefore the 
fever in its general character be very severe, serious, possibly 
fatal congestions, may have been already established, before 
the violent action of the capillaries of the skin which is ex- 
hibited in the eruption shall have begun to appear. If the 
heat and redness of the skin be very great, it will be found 
in almost every case, that blood-letting is improper, and if 
pain in the head and back, &c. shall have been sufficient to 
justify the belief, that fearful injections may have taken place, 
the lancet ought by no means to be used. Circumstances 



EMETICS. 263 



might occur, to justify the use of leeches for the relief of the 
head and throat, but even this practice should be employed 
with great circumspection. A gentle emetic, daily adminis- 
tered, if it be practicable, would be preferable. 

In many instances, when the skin shall have been very 
red for a day or two, the color changes with an inclination 
to a livid hue. This change indicates great prostration, and 
it may be inferred from it, that the sensorium is impaired, 
besides which, there will be symptoms proving the existence 
of thoracic and abdominal complication. The skin itself is 
in danger of losing its vitality — to blister the surface would 
be to institute the condition of gangrene. The stock of vi- 
tality is so low, that the whole surface needs to be cherished 
by wrapping the patient in a soft blanket, wrung out of hot 
water and alcohol, or vinegar, which should be warmed 
afresh, every hour. 

Emetics have been strongly recommended in some varie- 
ties of erysipelas. Desault considered this affection, in its 
common and genuine form, to be a bilious disease, and he 
treated it exclusively with antimonial remedies. We too 
have great confidence in the value of antimonial emetics in 
this disease, especially if they be properly aided by a daily 
use of the alcoholic bath, which is according to the views of 
Dr. Armstrong. 

In the early stages of measles and small pox, when the 
chest seems oppressed, threatening the lungs with conges- 
tion, Dr. Armstrong thinks that vomits are strongly indica- 
ted. He says, "when the lungs have been exceedingly 
oppressed, and particularly, when vomiting has been absent. 
I have often seen the most striking relief follow an antimo- 
nial emetic, which may fairly be ranked among the most 
efficacious remedies in pulmonic congestions. In this cli- 
mate, however, a majority of cases in measles and small pox, 
will require previous blood-letting. We have seen a case of 
small pox, which required four blood-lettings, in the course 



264 EMETICS. 



of the day preceding the appearace of the eruption. We 
proceeded according to the indications, and did not even sus- 
pect small pox, until it was beautifully displayed on the fol- 
lowing morning. In measles, whenever the lungs are dis- 
tressed and the pulse requires it, we let blood before we ad- 
minister the emetic or the bath. 

The use of emetics in croup is universally admitted, inso- 
much, that we believe they are now every where in this 
country thought to be indispensable. In ordinary cases, 
after using the vapor bath and suitable rubefacients to the 
sternum and throat, a decisive emetic serves to remove the 
disease. But in violent cases, when the breathing is very 
difficult, and the arterial system much disturbed, blood-letting 
is necessary. And it may be considered a good rule of prac- 
tice, if the hot bath, rubefacients and emetics fail to afford 
speedy relief, that blood-letting should be immediately added 
and carried sufficiently far, at once to make an effectual im- 
pression. Dr. Ferriar recommends blood-letting to deliquium, 
and in this we concur. If the case be violent it should al- 
ways be considered as a struggle between the Doctor and 
Death. The effect of the disease upon the state of the 
blood, is such, that the sensorium must soon lose its energies, 
and the whole system sink into fatal prostration. The blood- 
letting has .a tendency to relax the spasm of the glottis, to 
resist the inflammation of the trachea, and prepare the system 
for the full effect of the emetic. The great insensibility of 
the stomach, and indeed all the violent symptoms, may pos- 
sibly be consequent on some peculiar cerebral congestion. 
Blood-letting, therefore, releases the sensorium, and the 
nerves of the stomach are prepared to acknowledge the power 
of emetic substances. In the latter stages of croup, emetics 
are still useful, with a view to promote a more complete and 
effectual exhalation and expectoration of the viscid muciiSj 
svhich is so often troublesome towards the close of the disease, 



EMETICS. 265 



In cynanche tonsillaris, bleed decisively and give an 
emetic. 

In cases of pneumonia typhoides, emetics are much relied 
on. Having taken measures to prepare the system by the al- 
holic bath, and having let blood or not as the case shall re- 
quire, then suitable emetics operate with the best effects. 
The embarrassment of the lungs, and of course of the circu- 
lation, generally in such cases, is attributable to a strong ten- 
dency to venous congestion, and mild emetics frequently re- 
peated, will have the happiest effect on the returning circu- 
lation. When this practice shall have been sufficiently re- 
peated, the system will be found in readiness to profit by the 
remedies which are ordinarily recommended ; as small doses 
of opium and camphor, aided by bran tea, acidulated barley 
water, &c. remembering throughout, that blisters are of very 
great importance with a view of relieving the pulmonary af- 
fection, pain, &c. 

There is another affection which is vulgarly called bilious 
pleurisy, ('pneumonia biliosa,) in which emetics are likewise 
greatly serviceable. Richter speaks in high terms of the ef- 
fect of this practice, in removing excruciating pain in the 
thorax. Stahl also strongly recommends the use of emetics 
in this kind of pleurisy. As this disease frequently attacks 
persons of intemperate habits, and those particularly, whose 
livers are more or less torpid, it often takes on symptoms not 
much different from pneumonia typhoides. Hence it may 
present considerable variety of appearance ; from a high de- 
gree of inflammatory action requiring decisive blood-letting, 
down to a degree of prostration in which blood-letting is 
altogether inadmissible. After depletion when necessary, 
and the employment of measures for regulating and fixing 
the capillary excitement by the vapor bath, epispaiftics, &c. 
when blood-letting is forbidden, the emetic may be admin- 
istered, pro re nata. 

It is thought by many, that emetics will be found greatly 



266 EMETICS. 



useful in acute ophtalmia in all its various forms ; and why 
not equally so in chronic cases ? After the necessary blood- 
letting and a bold cathartic or two, we would not hesitate to 
have recourse to this practice. 

Many very respectable writers recommend emetics in the 
cure of acute rheumatism. Horn, in the Medical Recorder, 
recommends them very highly, and considers them more 
useful than any other class of remedies. His method is, to 
repeat them every day. up to the number of fifteen or twenty. 
But the disagreeableness of vomiting, will always make it 
difficult to carry such a practice into full effect. Richter 
speaks of a form of rheumatism, which occurs in low and 
marshy situations ; he calls it rheumatismus acutus gastri- 
cus ; depending, according to Stahl, on an irritation from 
vitiated or redundant bile in the prima via: in which, 
emetics are greatly serviceable. In all cases of this sort, the 
charges commonly raised against bile, ought to be attributed 
to venous congestion of the abdominal viscera. By being 
locked up in these viscera, the blood is not sufficiently circu- 
lated through the lungs, of course the sensorimm is imper- 
fectly supported and the blood is not sufficiently warmed. 
The system when thus poorly supplied with energy and 
warmth, if exposed to the vicissitudes of the weather, will be 
very seriously affected in a short time : and if it partake of 
that species of temperament, which is well inclined to take 
on rheumatic action, the disease as described by Richter, 
readily follows. It has frequently occurred under our obser- 
vation, and it will be readily relieved by an alternation of 
emetics and cathartics. The most effectual practice is, to 
take the first steps as we would do in any other fever with 
congestion of the abdominal viscera — bleed, cup, or leech, 
according to circumstances ; apply external heat, and after 
using hot cloths wrung out of hot water and vinegar, admin- 
ister an emetic. Afterwards proceed according to circum- 
stances, having recourse to blood-letting as the circulation 



EMETICS. 267 

may require it, always following the use of the lancet with 
an emetic ; but still having regard to the condition of the 
portal circulation, introducing suitable doses of jalap and cal- 
omel, &>c. as there may be occasion. A physician having 
experience in the treatment of bilious fever, would not long 
be at a loss to know, that this kind of rheumatism partakes 
greatly of the peculiarities of that form of fever, and of 
course, that it must be accompanied by a similar condition of 
the abdominal viscera. He will be led by analogy to employ 
emetics. If he have correct views of general principles, he 
will add blood-letting when necessary, and cathartics, and 
sinapisms, and epispastics, and external heat and quinine ! 
Perhaps no particular disease, affords stronger proof of the 
unity of general principles, or of the great importance of a 
right understanding of the manner in which sound medical 
philosophy can avail itself of the occasion, in any instance of 
disease — only let it be sufficiently removed from under the 
blind dictates of nosology. 



268 EMETICS. 



CHAPTER V. 

EMETICS— CONTINUED. 

If emetics are beneficial in the treatment of rheumatism 
when complicated with an irregular condition of the abdom- 
inal viscera ; by analogy, they ought likewise to be beneficial 
in gout ; and there are authorities which justify the practice. 
Our own experience in this painful disease, is more limited 
than in most other affections which are common to this coun- 
try. But we have seen it often enough, in its different 
stages, to know, that to a very considerable extent, general 
principles ought to be regarded in this, as well as in other 
diseases. A majority of patients in gout, will require blood- 
letting, in their youthful paroxysms. As they advance in 
life, they may require the various modes of treatment, which 
will be found detailed in the books ; and when there are in- 
dications to justify the use of an emetic, it ought to be admin- 
istered ; but not in those cases in advanced life, in which the 
disease has a tendency to fasten on the stomach. Mr. Alex- 
ander Small, a surgeon at Minorca in the Mediterranean, 
speaks in very high terms of the efficacy of tartarized anti- 
mony, in his own case of gout. He sometimes combined it 
with bark, and found a combination of the two articles, to 
act as a mild aperient. 

Mr. Saunders, in a treatise on certain diseases of the eye, 
found that the use of tartarized antimony, so as to excite 
nausea or full vomiting, was attended with great success. 
" In that variety of inflammation of the eyes called Egyptian 
opthalmy, Sir W. Adams speaks of the use of emetics in the 
strongest terms of praise. Emetics have been long since 



EMETICS. 269 



employed in the treatment of gatta serena, Richter consid- 
ered the disease to depend on some erroneous condition of 
the abdominal viscera, and employed them in conjunction 
with his deobstruent pill. 

Emetics have been recommended in hemopthysis. Dr. 
Eberle raises serious objections to their use, for reasons, how- 
ever, in which we are not prepared to concur. He thinks 
the full inspiration by which the lungs are expanded in vom- 
iting, would afford a more ready escape to the blood through 
the bleeding orifice, and that the effort must necessarily give 
an additional impulse to the circulation, both of which con- 
siderations ought to be weighed. Moreover, he thinks the 
pressure of the abdominal muscles and diaphragm, must im- 
pede the circulation in the abdominal aorta, which would 
therefore give a greater impetus to the blood through the 
superior arteries." An emetic ought not to be administered 
in any case of hemopthysis, when the arterial action is tense, 
without previous blood-letting. If the loss of blood have 
been sufficiently great through the ruptured blood-vessel, of 
course, that would be sufficient. But this never occurs, un- 
less the rupture be very considerable. In alL such cases, 
therefore, Dr. Eberle 's objection is worthy of regard. The 
greatest degree of stillness ought to be recommended. But 
in most ordinary cases, it will be found useful if not neces- 
sary, to let blood once. On the supposition that this opera- 
tion has been recently performed, the vena cava supplies the 
pulmonary arteries, and the pulmonary vein supplies the 
aorta ; — -administer an emetic, it first produces nausea, which 
reduces the power of the general circulation ; then, when the 
act of vomiting comes on, the excitement of the surface is 
immediately increased. The vomiting, is no sooner ended, 
than it is obvious, that the general circulation is equalized 
in a very harmless and moderate way. We infer, therefore, 
that the effect of the emetic on the general circulation is 
such, that the vena cava is not prepared to overstrain the 



270 EMETICS. 



pulmonary artery, within the short time occupied by one or 
more contractions of the abdominal muscles and diaphragm 
in vomiting, and that the hindrance given to the abdominal 
artery is not sufficient, within the same length of time, mate- 
rially to hinder the discharge of the pulmonary vein. More- 
over, the general diffusion of excitement which takes place 
in the whole cuticular surface, more than compensates any 
mechanical inconvenience, which the act of vomiting can 
possibly bring to the circulation. We are aware that Dr. 
Cullen found one case, in which an emetic increased the he- 
morrhage to an alarming degree. This we could expect 
under two circumstances. If the open vessel be large and 
the rupture extensive, no means ought to be used, which 
would compel the patient to move, and if the case require 
blood-letting, that is, if all the vessels are in the condition of 
injection, it is equally obvious that an emetic ought not to 
be employed, till after the necessary depletion. It is impor- 
tant to attend carefully to the fact, that hoemopthysis is pre- 
ceded by plethora and fever. We once saw a case in which, 
from the state of the pulse, we predicted a speedy occurrence 
of an attach of this disease, and before we could get ready 
with the utmost expedition to let blood, an alarming hemor- 
rhage took place, and it terminated fatally. Again, there 
will be found a constriction of the superficial vessels, concen- 
trating the blood into the viscera and producing a general 
stress upon the central arteries. In every such case, after a 
moderate blood-letting, an emetic will be useful. We con- 
stantly use remedies of this sort, so far as to produce nausea, 
in almost every case for which we prescribe in this disease. 

Dr. Eberle is disposed to think that the same mechanical 
reasons for objecting against the use of emetics, in hoemop- 
thysis, may be adduced in their favor in uterine hemorrhages. 
If he had merely insisted, that the same objections do not lie 
in the latter case, which have been adduced in the former, 
we should have had no objection to the reasoning, or its ap- 



EMETICS. 271 



plication. But it is important that we should not be mis- 
guided in our opinions of the modus operandi of medicines. 
The pressure made on the aorta must be unimportant, be- 
cause it is of so short duration. Besides, if it be considera- 
ble, it must imply an increase of its injecting power, during 
the time of the compression ; unless, indeed, we can be made 
to believe, that the pressure is made on a single point, after 
the manner of a ligature. The proper conclusion is, that 
emetics are useful in hemorrhages, because they have great 
power over the whole system, and do much towards the es- 
tablishment of a healthy general action, and thereby correct 
any morbid determination of the sensorial influence. 

In the treatment of dysentery, emetics have been long 
known and used, as being almost indispensable ; and when 
it is no more than a modification of marsh fever, which is 
often the case, emetics produce the same happy effects which 
follow their use in bilious fever. Sir John Pringle made use 
of this practice, and Clark, in his treatise on the diseases of 
the East and West Indies, informs us, that he derived the 
greatest advantages from the employment of emetics in this 
disease. Cleghorn says, " when dysenteries begin in the 
form of diarrhoea, without fever or fixed pain in the belly, 
the first thing to be done is, to empty the intestines of their 
acrimonious contents, as soon as possible." For this purpose 
he used ipecacuanha with cerated glass of antimony, in doses 
sufficient to operate freely, both by emesis and catharsis. In 
accordance with this practice, thirty or forty years ago, the 
planters in Virginia were accustomed to administer an ounce 
of sulphate of soda, together with a dose of tartarized anti- 
mony. The operation was considerable, but very commonly 
produced an excellent effect. It would be necessary, how- 
ever, to keep in view all the precautions which are to be re- 
garded in any other disease, and if there be a tense arterial 
action, and particularly if it be accompanied by pain in the 
abdomen, blood-letting ought to precede every other remedy; 



272 EMETICS. 



except in such cases of a secondary sort as occur after the 
system has been previously prostrated. In the treatment of 
diarrhoea, also, emetics are often found to be very beneficial • 
but in this as well as in dysentery, or any other affection in 
which the remedy is useful, its value is chiefly referable to 
its tendency to equalize the circulation, agreeably to the view 
already taken. 

In mania apotu, which arises from the intemperate use of 
ardent spirits, emetics have an excellent effect. This is the 
practice at present in Philadelphia, where it was introduced 
by Dr. Klapp. The same practice is pursued in other places, 
and will probably become general. It must be remembered, 
that the stomach is often extremely insensible to the opera- 
tion- of an emetic, and therefore that large doses are neces- 
sary. So soon as the vomiting can be made complete, the 
mental hallucinations are immediately much corrected, and 
if the case be of a mild form, a single dose serves, sometimes, 
to effect a cure. The practice, however, ought to be re- 
peated, from two to six or eight times, at such intervals as 
the judgment of the physician may deem it proper. We 
have been in the habit, chiefly, of relying on opium for the 
cure of this affection, and since we adopted the practice, 
have not failed once to recover our patient. But the practice 
of Dr. Klapp is, to rely almost entirely on emetics, voiding 
the bowels if necessary with suitable aperients. As it re- 
spects opium, he doubts the propriety of using it, except the 
emetic medicine should induce hypercatharsis. Dr. Eberle 
confirms this practice, assuring us, that emetics induce sleep 
more readily than opium, under any mode of management. 
In the cases which we have attended, the patients were much 
prostrated, and there was an unequivocal demand for opium 
and wine, and these remedies have had the happiest effect. 

We have intimated, that emetics would be found useful 
in other varieties of mania, and in hypochondriasis. In the 
commencement of a paroxysm of rage, if a sufficient dose cf 



EMETICS. 27£ 



tartarized antimony could be introduced, so as to excite co- 
pious emesis, it would scarcely fail to quiet the patient, and 
at the same time, it would promise advantage in view of ul- 
timate recovery. We knew a man in Virginia, who was in 
the practice of drinking to excess, at three or four periods in 
the year j when he commenced, seldom ceasing, until he 
had brought on mania. So soon as it had arrived at a cer- 
tain state of violence, the family would send for medical aid. 
By this time he had ceased to be able to serve himself with 
his drink, and a servant maid was compelled to hand it to 
him. We then could pour into his tumbler a portion of a 
solution of tartarized antimony, instead of water, and it was 
interesting to see how soon vomiting would restore his intel- 
lect. 

An emetic will rouse the hypochondriac patient from men- 
tal and physical torpor ; so that other remedies can be made 
to act. The modern practice in this case r is predicated upon 
the opinion, that the disease is consequent on chronic visce- 
ral congestion. Hence the employment of blue pill and oc- 
casional saline purgatives — the same sort of practice which is 
recommended in chronic affections of the liver and spleen. 
Frequent emetics in association with this practice, will al- 
ways be found to be useful. 

In puerperal mania this practice has been found to be par- 
ticularly beneficial. When the mechanical pressure made 
by the foetus, has subjected the viscera to the condition of 
debility peculiar to gestation and parturition with its accom- 
panying depletion, should a sudden collapse of the system 
occur, one of 'the consequent evils is, puerperal mania. Emet- 
ics seem to improve the state of the nerves, to agitate and 
resuscitate the torpid viscera ; secretion and absorption are 
again established, and the patient isTestored. But in this, 
as in any other affection, we must not be discouraged at an 
apparent failure upon the exhibition of a dose or two ; it 
must be repeated as often as the case may require. If the 

. 18 



274 EMETICS. 



abdominal viscera be relieved, the sensorium will regain its 
functions. 

In hysteria, so long an almost universally unmanageable 
disease, emetics are now found to be greatly useful. They 
are administered with advantage in almost every form of this 
protean disease, but more particularly in that form which is' 
attended with complete suspension of the animal functions, 
bringing on a state resembling syncope. Dr. Dean, in a 
paper published in the Medical Recorder, vol. 4, page 259, 
says " it is in the chronic variety of this complaint, in which 
the common routine of what are improperly termed antispas- 
modic medicines produce no other than transient relief to the 
patient, that I have experienced the most permanent good 
effects from the administration of emetics. In cases of this 
description, when the patients had labored under the disease 
for ten years, and during that time by the advice and direc- 
tion of respectable ph3 T sicians, exhausted, with at most, but 
teniporary benefit, the whole class of remedies which are 
usually prescribed, I have by the continued exhibition of 
vomits either entirely removed the complaint; or so far inter- 
rupted the habits of the diseased action in the stomach, that 
antispasmodic and tonic medicines, would in general com- 
plete the cure/*' Dr. Joseph Smith of New York, has re- 
commended emetics in equally strong terms in hysteria and 
epilepsy: and he considers them " more efficacious than any 
remedy ordinarily employed." 

In asthma, emetics are of unquestionable advantage, and 
particularly when lobelia inflata is employed as the emetic 
asent. We have used it. in frequent instances, with decided 
benefit. Dr. Porter of Pennsylvania, informed us, that it had 
not failed in his hands to afford relief in any case in which 
he had tried it. Dr. Eberleis inclined to the opinion, that 
the result was due to the mechanical effect of vomiting upon 
the diaphragm, in enlarging the thorax and thereby making 
more abundant room for the passage of the circulation through 



EMETICS. 275 



the lungs. It is probable that the expansion of the thorax 
does some good ; but we are confident that the shock given 
to the nervous system, does much more ; and the superiority 
of lobelia inflata, which is an antispasmodic, and almost a 
specific in the disease, goes far to confirm us in our opinion. 

Every physician is accustomed to the use of emetics in 
whooping cough, and will admit with us, that they afford 
more benefit than any other remedy in our profession. 
Whooping cough is, however, often marked with strong signs 
of plethora and inflammatory action. In such cases, emetics 
alone will not be effectuak Copious and timely blood-letting 
will always be found necessary, and when such is the case, 
if not employed within a reasonable time, the patient will 
perish. In many instances where blood-letting is not used, 
the patient is subjected to an affection like croup, which is 
superinduced, and then, nothing but copious bleeding can 
possibly prevent a fatal termination. 

Emetic# have been recommended in apoplexy; but there 
are good reasons for doubting the safety of fhe remedy. It 
must certainly be very proper if an emetic be tried in this 
disease, always to precede it with a sufficient blood-letting. 
Although it really seems to be a doubtful remedy, yet if the 
patient be attacked immediately after eating, or if there pre- 
viously existed known causes of gastric irritation, the use of 
an emetic is certainly indicated, and after the necessary 
blood-letting, it ought to be administered- But where there 
is no good reason to suspect a fullness of the stomach, nor 
any gastric irritation, the disease of course must be consid- 
ered as essentially connected with an engorgement of the 
cerebral vessels. Under such circumstances, the violent 
struggle which occurs in the act of vomiting, must do more 
harm than good. 

As to the use of emetics in epilepsy, the books give us 
very contradictory accounts ; some recommending, whilst 
others condemn them. Now, as each party is entitled to 



276 EMETICS. 



equal confidence, there remains but one way of reconciling 
them. We are willing to give due credit to both, and must 
therefore conclude, that each have used the remedy in differ- 
ent states of the system — the one probably without depletion, 
or before the system had, by time, become sufficiently passive 
to profit by the remedy — the other had reduced their patients 
artificially, or had the good fortune to find them reduced to 
their hand. To judge by what has occurred under our own 
observation, we are inclined to believe, that those who have 
found benefit from the practice, may have met with cases in 
which a morbid condition of the abdominal viscera had par- 
ticipation in the disease. We have frequently known the 
first paroxysm of bilious or intermittent fever in children, to 
commence with a violent convulsion. Possibly, then, some 
of the accounts may have been raised on occasions of this sort, 
and the commencement of an autumnal fever was considered 
the commencement of epilepsy. An emetic repeated as often 
as such convulsion should recur, would hardly fMl to afford 
relief; and a nosologist might readily enough make such a 
mistake. But there is another view of the subject which 
deserves to be noticed. Dr. Thomas says " when an attack 
of idiopathic epilepsy can be foreseen, there is perhaps no 
remedy which will be more likely to prevent the paroxysm, 
than v an emetic administered about an hour before its acces- 
sion. This is a very judicious view of the subject. Dr. J. 
Clark used the sulphate of zinc in a state of solution, pre- 
pared with an aqueous infusion of ipecacuanha. Dr. Eberle 
succeeded in the case of a child, by repeating a dose of ipe- 
cacuanha alone once every third day. 

There is of late a great prevalence of dyspepsia, and there 
can be no doubt of the value of emetics in this afflicting dis- 
ease. We put it down as a general cause of this affection, 
that every subject of it, has by some means, acquired the 
habit of over-eating — we mean too much for the digestine 
powers of his own system. No two persons can have' their 



EMETICS. 277 

blood-making organs precisely similar. The demands of na- 
ture in each of ten thousand, if they could be accurately 
measured, would present a different account. But it is the 
constant practice of mothers and nurses, and too commonly 
of fathers and other relations and acquaintances, to press and 
tempt children and their young friends to eat, and almost to 
eat incessantly. The consequence is, that in almost every 
instance, when there is not an iron conformation of the vis- 
cera, premature death or dyspepsia, or some definite disease 
of an important viscus is induced. In dyspepsia there is 
generally a great propensity still to eat on ; and whenever 
the stomach can be compelled to receive food, they continue 
to throw it in. By this imprudence, the system gradually 
runs into a worse condition, till eventually, a cure is imprac- 
ticable. According to this view, nothing would promise so 
much, as a frequent use of emetics, in the commencement of 
this disease. They will not only evacuate and improve the. 
state of the stomach and other viscera ; but they also check 
the insatiate demand for food, which perhaps is the most fre- 
quent cause of failure in our attempts to cure indigestion. 
In the advanced stages of the disease, we cannot perceive 
how they can do much good. There are occasions; how- 
ever, when we are obliged to employ them. Prof. Revere 
in a very good paper published in the Medical Recorder, says 
that persons of this description, whose* digestive organs have 
become much debilitated, sometimes on taking food, which 
in the healthy state of the stomach is perfectly innocent and 
nutritious, will be subjected to great general distress, numb- 
ness of the scalp, violent cholic, acute pain in the side and 
bladder, vertigo, apoplexy and convulsions. He relates sev- 
eral instances of this kind, in which the efficacy of emetics 
was very promptly and satisfactorily manifest. Dr. Wilson 
Phillip, however, very properly cautions us against too fre- 
quent repetition of the practice, in the further and more ad- 



278 EMETICS. 



vanced stages of the disease. He considers their use to be 
more or less important, according to the prevalence or recur- 
rence of irritating matter in the prima vice, and under other 
circumstances to be injurious, especially if too frequently re- 
peated. 

As it is supposed, that the good effect of emetics depends 
in a considerable degree, on their tendency to increase the 
activity of the absorbents, they have been much employed in 
every variety of dropsy. They have, however, been found 
to be more particularly beneficial in cases of anasarca and 
ascites. It is not greatly important to us to ascertain, 
whether emetics produce their good effect by increasing the 
action of the absorbents, or by diminishing the action of the 
exhalents • and by the by, we think they do both. They 
certainly improve the condition of the skin, and an improved 
circulation must carry over to the absorbents a better supply 
of the means of their support. By the nausea they lessen 
the force of the exhalents, giving the absorbents less to do ; 
and by improving the circulation of the skin they convey the 
blood to the absorbents in an improved condition : and the 
consequence is, that the absorbent system is ultimately re- 
stored to health. It is not improbable, however, that the 
best effect of emetics is produced by the improved condition, 
which they in many instances secure to t?he great abdominal 
viscera; the blood is more perfectly elaborated, and conse- 
quently all the organs and functions of the system are re- 
paired by that means. 

Emetics have also been recommended in diabetes. Rich- 
ter more particularly mentions several cases that were effec- 
tually cured by them. In many cases this disease depends 
on some visceral irregularity, and it is to be presumed, that 
such was the fact in many of the instances related by Rich- 
ter. When the liver becomes inactive in its functional ope- 
rations, we find the kidneys frequently performing secretions 



EMETICS. 279* 



in imitation of bile ; in proof of a disposition to act a vicari- 
ous part for the liver. Even the skin evinces a similar ten- 
dency. There is a great difficulty in making a thorough in- 
vestigation into the causes of diabetes. It never terminates 
in a short time, and oi course post mortem examinations, 
however carefully conducted, would present very uncertain 
appearances. If, however, it should turn out, that emetics 
do commonly produce appearances, such as those noticed by 
Richter and bring up great quantities of bilious matter ; and 
it seems in one case, that after such an evacuation the dia- 
betes disappeared in one night ; if the German physicians, 
who use these remedies very commonly in this disease, have 
detected its true pathology; the cure of diabetes by the repe- 
tition of emetics, will go far to prove, that this malady is one 
of the dread consequences of leaving the mesentery, when 
in a state of venous congestion, to be disencumbered by the 
unaided functions of the viscera. 

The importance of frequent emesis in jaundice has been 
long known, and whether the disease be consequent on tor- 
por, inspissated or viscid bile detained in the ducts or cist, or 
by a gall stone, the remedy is equally rational and proper. 
The relaxing or generalizing effect of an emetic, will be use- 
ful in preparing the system to come very advantageously 
under the agitation of vomiting, and the tendency of the me- 
chanical pressure to emulge the biliary duct, must be useful 
where there is detention or sluggishness in the passage of 
the bile through the ductus communis. 

After blood-letting and fumigation, if there should be de- 
lay in an attempt to reduce the swelling in a case of hernia 
humoralis, an emetic or two will be found useful ; more par- 
ticularly, if the tumor be very painful. But blood-letting 
and hot steam sufficiently repeated, are the most comfortable 
and effectual remedies that we have ever seen used in affec- 
tions of this sort. 



280 EMETICS. 



Br. Hossack of New York, in a paper which was published 
in the Medical and Physical Journal of that city, details seven 
cases of obstinate constipation of the bowels, in which emet- 
ics were of great service to the patients. He says "that in 
the commencement of constipation, or in its more advanced 
stages, when the symptoms of inflammation have been sub- 
dued by the lancet, emetics may be very advantageously ex- 
hibited ; both for the purpose of removing the hepatic ob- 
struction and of counteracting the spasmodic constriction and 
pain, ordinarily attendant upon the disease.*' Our own ob- 
servation confirms the propriety of this practice. Not unfre- 
quently, the true cause of such constipation, is the painful 
distension of the blood-vessels of the mesentery and intes- 
tines, as well as a torpid or congested state of the liver. Such 
is the inconvenience of that state of things, that the stomach 
and bowels are insensible to the impressions made by a ca- 
thartic in the common way. After blood-letting, however, 
a sufficient portion of tartarized antimony renovates the con- 
dition of the stomach : the agitation of emesis wakes up the 
portal circulation : the liver and all its appendages are roused : 
and the detained and distending fluids are passed off; leav- 
ing the viscera ready to perform their functions. This ex- 
position shall be made more satisfactorily, when we come to 
speak of catharsis. 

And here, whilst in view of the modus operandi of emet- 
ics, permit us to suggest a thought respecting the unity of 
disease. We have seen in how many apparently different 
affections emetics as well as blood-letting, have been found 
by experience to be greatly useful, and we are prepared like- 
wise to perceive, that the benefit attributable to the agency 
of emetics, is in no shape specific, further than the evacua- 
tion of the stomach is concerned. All their good effects as 
medicaments, are the results of a general agency, performed 
under the control of general laws, the operation of which is 



EMETICS. 281 



improved by the shock imposed on the nervous system, by 
agitation, by evacuation and inanition. A considerable error 
in the liver, or any other organ, disturbs the general harmo- 
ny; an ill condition of the blood in consequence of a torpid 
liver imposes unnatural labor on some other viscus, whose 
function is therefore, embarrassed. One error involves a se- 
cond, a second a third, and so on, until the contamination 
may be extended beyond the reach of recovery. And after 
all there is an unity of principle in the progress of disease, 
and an unity of agency in the modus operandi of the medi 
cines, by which disease is to be removed. 



282 CATHARTICS. 



CHAPTER VI. 



CATHARTICS. 



The intestines receive the chyme from the stomach, and 
aid in perfecting its assimilation for the support of the sys- 
tem. In performing this function, they are furnished with 
the secretions which are continuously supplied by the liver 
and pancreas, which, together with the secretions issuing 
from the pellicles of their internal surface, when commingled 
with the chyme, serve to change its condition, converting it 
into chyle. When the lactuals have taken up that portion of 
the chyle which is fitted for the purpose of nutrition, there is 
left a large amount of faecal matter, which, if detained, would 
be obnoxious to health. The intestinal tube, therefore, is 
prepared to perform an additional service. It becomes a co- 
laborator with the skin, lungs, liver, and kidneys, in exhaling 
and conveying away excrementitious matter. Suitable pro- 
vision is made to lessen the inconvenience which would oth- 
erwise attend it, by causing the discharge to be made peri- 
odical. The length and folds of the small intentines, serve 
in some degree to detain the aliment in its descent, but the 
saccated arrangement and peculiar location and flexure of the 
colon, constitute it a reservoir for the faeces, so as to secure this 
important object. Infants and young children, have frequnt 
and comparatively copious alvine evacuations, with a pecu- 
liar odor. They take a greater portion of nourishment in 
proportion to their bulk, than adults, and render greater and 
more frequent discharges necessary. Adults are commonly 



CATHARTICS. 283 



moved once in twenty-four hours, and the color and odor of 
their evacuations undergo a very great change from what they 
were in their infant and youthful state. There are great va- 
rieties, however, as to time, condition, &c, depending on 
the state of the viscera, and on habit. Some are always in- 
clined to looseness; others are always costive; some have a 
call once in twenty-four hours ; some once in three or four 
days ; others once a week. We knew one man and one wo- 
man, both of whom, often went several weeks without any 
evacuation from the bowels. We made an artificial anus for 
a child, when three months old, which previously had a small 
aperture only, which, with some difficulty, admitted the 
introduction of a common probe, through which a fluid es- 
caped, so as to stain its clothes. In every other respect the 
child had perfect health. 

We commonly use cathartic agents, with two intentions ; 
the one, to evacuate the bowels when in the condition of 
constipation ; the other, to increase the secretion of fluids 
into the intestines ; and this, in fact, is what we mean, 
when we speak of purging. It is in reference to these two 
intentions, that we distinguish between laxative and purga- 
tive medicines. The latter act by their stimulating power, 
which will commonly be in proportion to the quantity or dose 
administered. 

But as in many parts of the intestinal tube, its contents are 
carried in a direction which has to oppose the laws of gravi- 
ty, it is evident that a considerable force must be exerted 
from the stomach downward, or onward, in order to prope 
the alvine discharges in a regular manner. The force which 
performs this propelling effect, is called the peristaltic action, 
and this action is a regular series of contractions of the mus- 
cular fibres of this organ, from above downwards. An inad- 
equate force of this action will produce constipation. The 
same may be the effect of mechanical resistance, or a defU 



284 CATHARTICS. 



cient secretion of the fluids intended for dilution, fyc: or 
more than one of these causes may combine to produce con- 
stipation. 

If any article of medicine therefore, increases the alvine 
discharges, it must produce the effect, either by increasing 
the peristaltic action of the bowels, or by increasing secre- 
tions, or by removing the impediments which hinder its reg- 
ular powers, or by producing these effects simultaneously. 

Cathartics increase the peristaltic action, provoke an in- 
creased secretion, and so diminish the resistance made to 
the passage of the substances propelled, by lubricating the 
internal surface, and rendering the substances more fluid. 

In the catalogue of agents of this class, we have articles 
which possess different degrees of cathartic power, which 
enables us to adjust them to all the variety of cases which 
can require their use. We have them too, with peculiar dif- 
ferences of agency, in relation to the parts of the intestinal 
tube, upon which they more immediately exert their action, 
and also in relation to the nature and appearances of the dis- 
charges which they procure. 

As examples, calomel, gamboge, jalap, act, more particu- 
larly upon the prima viae, and upper portions of the intes- 
tines ; castor oil, colocynth, and some others, act with a more 
extensive range upon the intestinal tube ; whilst aloes acts 
almost entirely upon the lower portion of the bowels. We 
have it in our power too, to make a selection of our article, 
in view of the kind of discharge we may wish to produce. 
Jalap, and the different saline purges, produce copious watery 
discharges. Castor oil and rhubarb, merely evacuate the 
contents of the bowels ; whilst calomel and gambouge in- 
crease the secretion of bile, and carry it off in very copious 
quantities. 

Dr. Paris seems to think, "that a medicine may act more 
immediately and especially upon the stomach, or the small or 



CATHARTICS. '28£ 



large intestines, according to the relative facility with which 
its principles of activity, enter into solution ; that those which 
are dissolved before they pass the pylorus, are quick and vi- 
olent in their effects, and liable to affect the stomach; as is 
exemplified in the action of gamboge, &c, whilst some re- 
sinous purgatives, on the other hand, as they contain princi- 
ples less soluble, seldom act until they have reached the co- 
lon. Colocynth, has a wider range of operation, because its 
principles of activity reside both in soluble and insoluble ele- 
ments. Aloes again, being still further insoluble, passes 
through the whole alimentary canal, before it is sufficiently 
dissolved, and acts, therefore, more particularly upon the 
rectum." 

These circumstances are particularly worthy of notice, 
both in a therapeutical and pharmaceutical point of view, 
since it will enable us to modify the peculiar action of these 
remedies, by having a due regard to their degree of solubility, 
and to select such articles as may most effectually correspond 
to the intention, in view of the circumstances of the diseases 
for which we may prescribe them. 

If we would treat an ascites, we would naturally be induc- 
ed to exhibit such articles as have the greatest tendency to 
evacuate much serum from the intestines. We of course 
select the saline substances. So likewise, in cases attended 
with a redundancy of vitiated bile, we would have recourse 
to those articles which act upon the upper portion of the in- 
testines, and at the same time rouse the functions of the bili- 
ary system. We therefore exhibit calomel, gamboge, ipeca- 
cuanha, &c. If, again, we wish to evacuate the bowels, and 
at the same time produce some effect upon the pelvic viscera, 
as on the uterus in amenorrhse, we then select aloes, because 
of its known effect on the rectum. In addition to these im- 
mediate effects of the different cathartic agents, they admit 
of application on general principles, which we have yet to 
consider. 



286 cathartics. 



1st. They diminish the action of the heart and arteries, 
and thererore are used with more or less advantage in most 
diseases of an inflammatory character. They produce this 
effect not merely by evacuating the bowels of their vitiated 
and accumulated contents, thus removing such causes o£irri- 
tation, but they indirectly evacuate the blood-vessels, by in- 
creasing the secretions of serous fluid from the alimentary 
canal. Dr. Eberle thinks their operation in this respect, re- 
sembles in some degree the effect of blisters, which, though 
acting primarily as stimulants upon the sanguiferous system, 
reduce its action, as a secondary effect, by the effusion of the 
serum which they occasion. We are ready to admit the sim- 
ilarity as far as it obtains, but we object to the comparison 
made in this place. Blisters act chiefly by stimulation, ca- 
thartics by evacuation. 

2d. Cathartic medicines promote the absorption of fluids, 
from the internal cavities. As they provoke a discharge of 
serum from the blood-vessels, they thus indirectly prepare 
the absorbents to take up a supply from those cavities, in 
which it may exist in a siate of morbid accumulation. It 
appears to have been established by the experiments and pa- 
thological observations of Magendie and others, that absorp- 
tion is accelerated, in proportion as the quantity of fluid cir- 
culating in the blood-vessels is diminished. It is thought 
moreover, that there is a constant effort in the system to 
preserve the regular portions of serum in the blood, and that 
any loss by one outlet is compensated either by an absorp- 
tion from some of the internal cavities, or by the diminished 
action of one or more of the serous emunctories. For exam- 
ple, when the exhalents of the peritoneum effuse a preter- 
natural quantity of serum into the abdomen, producing asci- 
tis, the morbid diminution of this fluid in the blood-vessels, 
is in some degree compensated by the diminished action of 
the cutaneous exhalents and of the kidneys. But if we suc- 
ceed in exciting the kidneys into a more perfect performance 



CATHARTICS. 287 



of their functions, some new supplying power will be requi- 
site to keep up the necessary proportion of serous 'fluid 
in the blood-vessels. The absorbents are therefore called 
into action, and the dropsical fluid is reabsorbed into the 
circulation, and then eliminated by the regular emuncto- 
ries. 

Cathartics irritate the exhalents of the internal surface of 
the intestines, by which a very great secretion of the serum 
is suddenly produced. The consequence is, a diminution of 
the effusion of the dropsical fluid j because the action of the 
exhalents, that is, of the arteries, is diminished, accompa- 
nied by an increased action of the absorbents, which go to 
work to supply the deficiency thus produced by the increas- 
ed action of the exhalents, which is performed in obedience 
to the mandate of the cathartic. 

Dr. Paris and others state, that cathartics often increase 
the effect of diuretics. For instance, if we give a diu- 
retic remedy to a dropsical patient, it may be, it will pro- 
duce a very insufficient increase of urinary secretion. The 
absorption remains proportionally small. Under these cir- 
cumstances let a cathartic be administered. This will dis- 
charge a considerable portion of serum from the bowels, 
which will create a demand for the restitution of this con- 
stituent portion of the blood ; consequently a new impulse is 
given to the supplying, that is, the absorbing vessels, which 
continuing after the operation of the cathartic ceases, will 
have the effect of supplying the kidneys with a larger por- 
tion of the elements, which employ their functions, and of 
course, it will appear that the diuretic is made satisfactorily 
effectual. 

3d. Cathartics have a tendency to remove the torpor which 
so often prevails in the portal circulation ; and in that way 
promotes the biliary secretions. They do this, in the opin- 
ion of Dr. Johnson, by exciting a brisk peristaltic motion of 
the intestines, whereby the blood which is accumulated and 



288 CATHARTICS. 



almost stagnated in the portal circles is propelled forwards. 
This is one of the most important facts in view of the good 
effects of cathartics in the treatment of fever, particularly in 
children, and in the fevers which prevail in the summer and 
autumn. 

4th. They provoke a determination of the circulating flu- 
ids, to the abdominal viscera, affording relief when necessa- 
ry, to the vessels of the head and thoracic viscera. But to 
secure this intention, it is generally necessary to premise 
blood-letting. Dr. Paris says, "I have often noticed this 
fact, in contending with a plethoric diathesis, whenever bleed- 
ing preceded the purgative, the effect of the latter has been 
uniformly more speedy and considerable. In obstinate con- 
stipation, the same fact has been observed, and mild reme- 
dies have been known to act more powerfully when preced- 
ed by blood-letting, than potent ones have done, when ex- 
hibited antecedent to it. 

After these four general statements respecting the proba- 
ble modus operandi of this class of remedies, we will offer 
some therapeutic details, for regulating their use in particu- 
lar diseases. 

In almost every variety of febrile disease, cathartics are 
commonly considered indispensable, and as holding rank 
amongst the most important curative means we possess. 
The alimentary canal has been called " the storehouse of 
disease/-* Here our views differ materially from all we have 
seen written on the subject. One of the most respectable 
paragraphs that* we have met is the following: i; Whatever 
may be the original febrile cause, whether seated in the bow- 
els or elsewhere, it is certain, that the secretions which are 
poured into the alimentary canal, are perhaps in almost eve- 
ry instance of fever, changed from their natural or healthful 
condition, to a state which renders them additional causes 
of irritation to the already preternaturally excited system."' 
It certainly is important to remove such causes of irritation. 



CATHARTICS. 289' 



throughout the whole course of nearly all acute diseases. 
But their good effects are not confined to the mere evacua- 
tion of the vitiated and irritating contents of the bowels. 
They are useful on account of the indirect depletion of the 
blood-vessels and consequent subjugation of the vascular ac- 
tion which accompanies irritation. Commonly, in the first 
stages of all fevers, we should select such cathartics as are 
calculated at once to evacuate the contents of the bowels, 
completely, and procure an abundant effusion of serous fluid 
from the intestinal cxhalents. With- this intention, the sa- 
line cathartics are generally preferred in the ordinary syno- 
chus fevers. But if the disease be attended with functional 
derangement of the biliary system, which is generally the 
case in intermittent and remittent fevers, we add such arti- 
cles as are known to correct disordered hepatic secretions ; 
and with that intention, we add calomel to other appropriate 
cathartics. 

Typhus fever was considered for ages as being essentially 
characterised by debility, and cathartics were almost univer- 
sally considered improper in its treatment, until Dr. Hamil- 
ton, of Edinburg, established their utility ; and the truth of 
his observation and experience is generally admitted. Dr. 
Rush long since called attention to the fact, that purging re- 
moves the apparent debility which frequently exists in the 
latter stages of acute diseases. In yellow fever, he often saw 
the prostrated strength of a patient suddenly renovated, by 
the operation of a cathartic. Irritating matters acting on 
the intestinal nerves, can produce very alarming debility. A 
meal of indigestible food, in persons of weak digestive pow- 
ers, has often brought on the most alarming prostration of 
strength. We restrict our patients from taking articles which 
in health would be too light for their ordinary support, be- 
cause we fear that their blood-making organs might be weak- 
ened, convalesence interrupted, or that a tumult would be 
19 



290 CATHARTICS. 



raised, dangerous to life. And if this precaution be reasona- 
ble, is it not obvious, that the retention and irritation of viti- 
ated matters in the intestines of debilitated typhous patients, 
must certainly have a tendency to produce very pernicious 
consequences. That the secretions of the abdominal viscera 
are vitiated in typhus fever, and indeed, in all protracted 
fevers, there can be no doubt. The appearance of the 
discharges, the suspended digestion and morbid state of 
the foeces, sufficiently confirm it. If there were no other 
object in view than the removal of the morbid and irritating 
materials, we cannot fail to perceive the utility of employing 
mild purges, during the latter state of typhus fever. By re- 
moving such cause of irritation, we renovate the vital powers 
and prepare and provoke the intestinal emunctories to resume 
their natural functions. 

;: I have directed," says Dr. Hamilton, " a strict attention 
to this practice for a long time, and am now thoroughly per- 
suaded, that the full and free evacuation of the bowels, re- 
lieves the oppression of the stomach, cleanses the loaded and 
parched tongue, and mitigates thirst, restlessness, and heat of 
surface ; and that thus the latter and more formidable im- 
pression on the nervous system is prevented, recovery more 
certainly and speedily promoted, and the danger of relapsing 
into fever much diminished.'' He furthermore informs us, 
that "he is disposed to refer the superior utility of purga- 
tive medicines in typhus fever, to the circumstance of their 
operating throughout the whole extent of the intestinal ca- 
nal : to their acting upon an organ, the healthy functions of 
which are essential to recovery, in a manner that is conso- 
nant to the course of nature, by propelling its contents from 
above downwards."' " Enemata, whose effects are confined 
to the rectum, must be altogether inadequate to procure the 
full evacuation which the circumstances of the case require. 
It will be noticed, that the practice is intended to be consid- 
ed only #s applicable to the latter stages of typhus fever. In 



CATHARTICS. 291 



its commencement, when vascular action is considerable, 
free purging with brisk agents is necessary, not only for the 
purpose of unloading the bowels of their irritating contents, 
but also for the more important purpose of their depleting ef- 
fects on the blood-vessels. 

Dr. Armstrong confirms this view. " Purgatives," says 
he, " seems beneficial by unloading the intestines of faeces 
and excrementitious matter, which when retained, excite and 
keep up much general irritation. But is it not exceedingly 
probable, that they have another and far more salutary effect 
in restoring healthy secretion, and in diverting irregular de- 
terminations of blood from the head, liver, and other parts ? 
The full operation of aperients sometimes corrects an un- 
natural heat of the skin, or a morbid state of the pulse, al- 
most as effectually as the affusion of cold water or venesec- 
tion ; consequences which surely indicate that the action ex- 
tends further than the mere removal of foecal matter from the 
intestinal canal." The doctor does not seem to have con- 
sidered, that the inconveniences named, might all have been 
produced by intestinal irritation, and its removal of course 
would procure the retirement of its effects. He adds, "I 
believe that purgatives are also beneficial, by preventing 
through their operation, the absorption of the morbid secre- 
tions and excrementitious matters of the intestines ; for when 
these have been allowed to be retained in typhus, I have 
generally observed a considerable increase of irritation, with 
an offensive odor from the lungs and from the skin ; and on 
the contrary, when the morbid secretions and excrementi- 
tious matters have been regularly evacuated, there has been 
mostly a diminution of irritation, with an absence of the pe- 
culiar odour." 

Much judgment is necessary in making our selection of the 
proper article for purging usefully in typhus fever. In the 
commencement, calomel — or calomel and jalap — or calomel 
with jalap and aloes — neutral salts, or infusion of senna — or 



292 CATHARTICS. 



senna and salts combined, may be employed. These should 
be used with decision in the beginning ; afterwards half a 
grain of calomel, with one grain or less of ipecacuanha every 
morning and evening, with a continued use of rheum and 
serpen taria. 

In exanthematous fevers, cathartics are very useful reme- 
dies ; so long as it is proper to keep in subjection the excite- 
ment of the skin ; and it is unquestionably a morbid excite- 
ment of the skin which constitutes these diseases. As cold 
air, tepid bathing, and ablutions act kindly in such affections, 
so also do cathartics, with this difference — ablutions mode- 
rate and improve the excitement of the skin ; cathartics only 
procure a reduction of the action. The one therefore can- 
not be a proper substitute for the other. Cathartics deter- 
mine the circulation upon the intestines, and effect a simul- 
taneous diminution of the action of the skin — the converse 
of which is produced by sudorifics, and therefore by the pro- 
per use and alteration of these two modes of treatment, we 
may manage exanthematcus diseases, not always however 
without blood-letting. 

In scarlatina simplex and scarlatina anginosa, purges are 
useful. Drs. Hamilton and Armstrong, have added their tes- 
timony in favor of this practice, which is now pretty gene- 
rally adopted. In these affections, it is necessary in the be- 
ginning to produce brisk and copious evacuation. Dr. Arm- 
strong recommends sulphate of magnesia with tart, antimo- 
ny, so as to produce rapid purging and vomiting. The sys- 
tem may be in plethoric condition, with tendency to irrita- 
tion, and escape observation. Such is the state of things of- 
ten in the commencement of catarrh. On letting blood free- 
ly, the morbid condition may seem to be corrected. If how- 
ever, the intestines shall need evacuation : if an appropriate 
cathartic should be required, and be overlooked, aud the pa- 
tient expose himself to the weather — in consequence of the 
debility of the capillaries of the skin, produced by the bleed- 



CATHARTICS. 293 



ing, a constriction will follow — the circulation will be brought 
again into a state of stress, and an irritation will as certainly 
be the result, as if the blood-letting had not been performed ; 
indeed the secondary irritation may be more serious than the 
first. 

This will always be found a very proper, and sometimes 
necessary practice. After the disease shall have had any 
standing, so as materially to affect the vitality of the skin, 
blood-letting is inadmissible, and strong and brisk purging 
are in like manner to be avoided. We have used reiterated 
small doses of calomel and ipecacuanha, in all cases of scar- 
latina anginosa, after the disease has progressed till the throat 
is considerably sore, and the tongue and fauces are much 
coated with sordes; paying attention to the skin, according 
to the views submitted in the chapter on emetics. 

In erysipilas, ordinarily, purges are useful, but it is emphat- 
ically important in this affection, to have regard to the state 
of the stomach and intestines, and take special care to guard 
against a collapse of the skin, and an introversion of the ex- 
citement. To use a vulgar explanation, we must take care that 
the disease does not turn in upon the bowels, which it often has 
a very great tendency to do. We explain this by considering 
the patient to have been in a state of debility before the at- 
tack — produced by the agency of cold, upon a temperament 
favorable for the production of erysipelas. The eruption is 
consequent on an. imperfect attempt at a recovery of the ex* 
citement of the skin. To deplete therefore, under some cir- 
cumstances, would produce a dangerous collapse. After it 
shall have produced general irritation, and a consequent re- 
action determined to the head, then blood-letting is an ap- 
propriate remedy. 

In dysentery, most decidedly cathartics are beneficial. If 
the disease be consequent on the detention of foeculent mat- 
ter, it is obvious that this must be removed. If it be the re- 
sult of venous congestion, evacuation from the bowels is 



294 



CATHARTICS. 



equally necessary. The disease implies an irritated condi- 
tion of the bowels — all irritating agents therefore must be 
speedily removed. It is important also, that we should be 
careful to make a judicious selection of the article with which 
we propose to accomplish our intention. In the commence- 
ment something which shall act decisively and freely ; af- 
terwards, castor oil, or sulphate of magnesia, and if necessa- 
ry, these alternated with calomel, or calomel and ipecacuanha 
combined, according to circumstances. But in a majority of 
cases, after decisive depletion by blood-letting, when admis- 
sible, and a suitable cathartic once or twice administered, a 
good dose of castor oil, with ten, or fifteen, or twenty drops 
of laudanum may be employed as often as the tormina and 
tenesmus recur. And with a proper attention to the skir , 
this treatment may be relied on for a cure. 



CATHARTICS. 295 



CHAPTER VII. 

CATHARTICS— CONTINUED. 

Cathartics are valuable in the treatment of puerperal fever 
and peritonitis. In affections of this sort, brisk purging in 
the onset, very often, will be found effectually to arrest their 
their further progress. If the attack be acute, the most deci- 
sive blood-letting will always be indispensable ; afterwards, 
cathartics suitably adjusted to the demands of the case, with 
cupping and leeching, will constitute the principal remediate 
measures, and upon which we most rely. Our observations 
have led us to believe, that in the fever most commonly met 
in childbed, the peritoneal coat nf the intestines, is more fre- 
quently concerned than the uterus. As in other instances of 
inflammatory affectines of the intestines, there is a general 
soreness of the abdomen, and in very bad cases, the abdo- 
men becomes tumid and hard. Constipation also often ob- 
tains to a very alarming degree. Therefore, after blood-let- 
ting, when necessary, brisk cathartics ought to be adminis- 
tered, and they will be more or less beneficial, according to 
their activity. Sometimes there is difficulty in effecting ca- 
tharsis, so great as to require strong doses of calomel and ja- 
lap, which ought to be fearlessly administered, whenever 
necessary. There have existed very great errors in the opin- 
ions of physicians upon this subject. Drs. Abercrombie and 
Broussais, must have been in error when they wrote against 
the use of cathartics in peritoneal inflammations. Broussais 
says, they are hurtful, because the vermicular contractions 
which they excite in the intestines, must increase the mor* 



296 CATHARTICS. 



bid sensibility of the peritoneum. In abdominal inflamma- 
tion, provided the mucus tissues are not inflamed, cathartics 
excite the secreting vessels, and that not only of the whole 
external surface of the intestines themselves, but also of the 
glandular organs, whose excretory ducts open into the primas 
vise ; and by the most direct channel within the reach of art, 
•deplete the vascular portion of the abdominal viscera. When 
the intestines are inflamed, the peritoneal covering which is 
reflected over them, will of course be more or less implicat- 
ed. However much this may be the case, if the villous coat 
of the intestines remain unaffected, the alimentary canal 
will commonly be found in a condition, which uniformly de- 
mands the aid of cathartic remedies, and the most direct pos- 
sible way to relieve the peritoneum, is to evacuate the con- 
gested vessels of the abdominal viscera. To excite the mu- 
cous membrane therefore, will as certainly relieve the peri- 
toneal inflammation 3 as a free expectoration from the mucous 
membrane of the lungs, will relieve the vascular turgescence 
and inflammation of the parenchymatous structure or pleural 
covering of that organ. It may be proper, however, before 
we dismiss this subject, to observe, that in some instances of 
great prostration in childbed, the intestines may be in a con- 
dition which will require much care and management, espe- 
cially when worn down by long continued diarrhoea. It 
may be necessary to use small doses of calomel and opium, 
to be aided by occasional doses of castor oil ; infusions of sen- 
na, with or without the addition of a little sulphate of mag- 
nesia ; epispastics, external warmth, semicupium with vine- 
gar : sinapisms, the vapor bath, &c. 

Cathartics properly belong to the class of antiphlogistic 
medicines, and therefore there are very numerous instances 
of inflammatory disease, in which they are useful. In 
pleurisies they are of less importance, and sometimes become 
injurious. In these affections we rely chiefly on blood-let- 
ting. But in rheumatism they are generally useful. Dr, 



CATHARTICS, 297 



Scudamore, in his treatise on the nature and cure of gout 
and rheumatism, says, that the advantage of making a de- 
traction from the general circulation, by the channel of the 
alimentary canal, is no less remarkable in rheumatism, than 
in every other inflammatory disease. In proportion as we 
pursue this practice from day to da}?-, we obtain its effect in 
acute rheumatism ; the circulation becomes moderated ; the 
inflammatory diathesis subdued ; and the absorbent system 
is excited to increased action." This statement accords with 
our own experience. The true reason why the use of ca- 
thartics ever became doubtful has been, that they have been 
used too sparingly. By pressing the system hard with rei- 
terated purging, " we promote the removal of excessive se- 
cretions of the synovial membranes, which causes the dis- 
tention and impedes the motion of the parts affected. Sa- 
line purgatives administered in small doses, and repeated at 
intervals, are the most advantageous." This last is a cor- 
rect view of the practice in cases of long standing, in which 
the system is worn down to a state of debility. In the ear- 
ly stages one or two blood-lettings may be employed, and 
when by the reiterated use of gentle cathartics, we keep 
down the inflammatory action ; and we excite the absorbent 
system, when sufficiently reduced, to obey a treatment less 
powerful in its effect. It may be remembered however, that 
it is important in the cure of rheumatism, to have special re- 
gard to the state of the skin. All the different unguents, lin- 
iments and opodeldocs, have obtained their reputation chiefly 
because, either the friction necessary to make the application, 
or the irrigating qualities of them, or both conjoined, or the 
necessity of making the application before a hot fire, or un- 
der the influence of a hot shovel, have served to keep up the 
excitement of the skin. Sinapisms and epispastics are per- 
manently useful, then only, when they make an impression 
on the skin, which ensures a permanent excitement of its 
vessels, so as to maintain its functions. In view of this im- 



298 CATHARTICS. 



portant consideration, we conduct the use of cathartics in 
rheumatism. After depletion shall have been carried to a 
certain extent, the skin will be in danger of losing its excite- 
ment. When we arrive at this stage, we must be careful as 
to the quantity of blood to be drawn, and also as to the pow- 
er of the cathartics to be used. It is equally important not to 
repeat either, until the system reports itself in readiness for 
permanant reaction. Aided by a proper use of heat, sina- 
pisms, frictions and blisters, so as to compel the skin to keep 
time with our depletions, we can bleed as often and give as 
many cathartics in six days, as can safely be done in nine 
without the necessary attention to the skin. 

Very nearly the same practice, and all its discretions are 
equally appropriate in the treatment of gout. Whatever be 
the real nature of this painful disease, we are of the opinion, 
that there is always some organic disease, some functional 
derangement of the liver and portal system of vessels. This 
is also the opinion of Dr. Scudamore. Admitting this, there 
can be no doubt respecting the beneficial effects of purging 
in gout. This practice is also recommended by Dr. Sutton. 
The experience of the faculty in relation to gout, has led to 
the adoption of a practice in full accordance with the discre- 
tions which we have submitted in relation to rheumatism. 
Dr. Scudamore informs us that " he invariably employed, 
with the greatest advantage, purgative and diuretic medicines 
conjointly; so that the exhalent vessels of the alimentary 
canal, and the secreting function of the kidneys, are stimula- 
ted to increased action at the same time." Such a union of 
purgatives and diuretics, is particularly serviceable in those 
cases that are attended with dropsical effusions in the ex- 
tremities. In any such case, and indeed in all cases of gout, 
regard ought to be had in a very particular manner, to the 
general temperament of the patient, and also to any organic 
temperament which may obtain in the case, especially to the 
habitual state of the patient's skin. And if he have been ac- 



CARHARTICS. 299 



customed to a constant moisture of the surface, every suitable 
measure must be adopted to insure the concurrence of the 
skin, in the train of t arrangements which enter into the plan 
of treatment. It will of course be seen, that sometimes it 
may be necessary to unite diuretics, cathartics, and diapho- 
retic medicines, in order to do ample justice to a gouty 
patient. 

In hydrocephalus internus, cathartic medicines are indis- 
pensable. Physicians of late years seem to have to a pretty 
general consent of opinion, that the symptoms ordinarily at- 
tendant upon hydrocephalus are often consequent on gastric 
irritation. The disease in such cases, first evinces its ap- 
proach by great disturbance of the stomach and bowels, and 
the " alvine discharges afford unequivocal proof of great 
functional disorder of the liver. They commonly consist of 
large quantities of black or green or glary bile, and are sel- 
dom if ever found to exhibit the appearance of natural and 
healthy evacuations. Dr. Cheyne, in his post mortem exam- 
inations, found in the liver, the remains of great inflammatory 
action, with appearances proving that undue irritation had 
existed in the alimentary canal. Mr. Abernethy also found 
the brain of a child, that had died of what were considered 
unequivocal symptoms of hydrocephalus, to be perfectly 
healthy; the only, disease being in the bowels. Dr. Cheyne 
mentions a very remarkable case of a girl, who complaining 
in the evening of a headache, was put to bed by her mother 
and soon fell asleep • next day at noon she was still sleeping, 
respiring fully and slowly, with now and then a heavy sigh : 
the eyes were fixed, the pupils large and immoveable. She 
had been very costive for some days previous, and was lan- 
guid : she was ordered an enema and this roused her, so as 
to swallow a bolus of jalap and calomel, which operated pow- 
erfully and brought away two chamber pots full of the most 
extraordinary collection of faeces the Doctor ever saw. This 
patient recovered immediately. In accordance with the 



300 CATHARTICS. 



opinion which this case is intended to inculcate, cholera in- 
fantum very often terminates in unequivocal symptoms of 
hydrocephalus acutus. We have often seen very alarming 
appearances, such as indicate danger to the head, corrected 
immediately by jl plentiful catharsis; and sometimes by the 
administration or a simple enema. According to our obser- 
vation, a great proportion of children are over-fed. Their 
brains are greatly irritable, and a fever which in reality has 
its origin in a morbid condition of the viscera, will be found 
seriously to affect the head. There would be no hazard, 
therefore, in believing that nearly all the instances of this 
disease, which are not produced by falls or some other known 
injury done to the head, are primarily diseases of the viscera ; 
and that the injury sustained by the sensorium. is superin- 
duced by the violence and continuance of the fever. But 
whether the disease be idiopathic or secondary, purging is 
equally necessary in both. The propriety of cathartics is 
most obvious when the disease is dependent on an irritation 
of the intestines, as in such cases, they tend at once to re- 
move the cause of irritation, and by producing a determina- 
tion of the fluids to the intestines, diminish the quantity 
which would otherwise have been determined on the brain. 
The bowels, therefore, ought to be actively moved, in every 
case where the symptoms indicative of hydrocephalus are 
found to supervene. Dr. Cheyne, in his essay on the dis- 
eases of children, says : " Should we ascertain, that the ali- 
mentary canal is torpid and imperfectly performing its func- 
tions, admitting an accumulation of foeculent matter, or that 
the secretions flowing into it, are vitiated or diminished in 
quantity, which we discover by the peculiarity in the appear- 
ance, or by the pungent foetor of the stools, we must, by 
steadily pursuing the purgative plan, endeavor to effect a 
change in the hepatic system, the alimentary canal, and all 
the parts, including every organ essential to life, which is 
connected with them." This is in perfect accordance with 



CATHARTICS. 30 1 



the experience of every judicious physician in this country. 
If the facts and arguments adduced, in proof of the propriety 
of purging decisively in hydrocephalus, be admitted • if ca- 
thartics determine the circulation from the head and remove 
the causes of intestinal irritation, it must be obvious, that they 
will likewise be useful in apoplexy; and for the same rea- 
sons ; — with a view to diminish the afflux of blood to the 
head and direct it upon the intestines and other abdominal 
viscera ; and the more decisive the purges, the more bene- 
ficial will be their operation. 

Hypochondriasis is produced by a diseased state of the 
chylopoietic viscera. It is the ordinary course of it, first to 
take on the symptoms of dyspepsia ; the appetite is either 
morbidly increased or diminished ; a distressing sense of full- 
ness is experienced in the stomach, with foetid belchings ; 
white tongue ; obstinate constipation ; and headache. These 
are unequivocal evidences of visceral disease ; yet in this af- 
fection, brisk purging does not produce a good effect. Ordi- 
narily, the viscera are in a state of too great debility, to en- 
dure drastic purges. We have thought that most cases of 
this sort, are consequent on a state of things, approximating 
to. schirrus. If the evacuations be too considerable, there- 
fore, they will serve only to increase debility; inasmuch as 
the vessels are not prepared to keep time with the depletion. 
The kind of practice which the experience of the profession 
has led them to adopt, is the frequent and almost daily use 
of laxatives. By gently exciting the bowels in this way, we 
in some sort, substitute the natural intestinal and hepatic se- 
cretions, and counteract the torpor which in this disease pre- 
vails in the portal circulation. To accomplish this, we unite 
purgative articles with mil# bitter tonics, and give them, so 
as. to procure one or two good evacuations in the course of 
twenty-four hours. When the disease is of long standing, 
there is often the most remarkable constipation ; of course 
aa amazing quantity of foeculent matter is accumulated and 



302 CATHARTICS. 



impacted in the lower bowels. This must have a tendency 
to keep up and increase irritation, and what is particularly 
remarkable, purgatives do not remove it. When it is de- 
tected, in such cases, it is the practice to use mild but copious 
injections. 

The whole of this practice is merely palliative. Every 
such patient needs remedies which have a tendency to cure 
the visceral disease which lies at the root of the evil. He 
should be treated with the utmost respect, and be made fully 
to understand that he is laboring under a disease which re- 
quires steady and long continued attention. We use a pill 
of calomel and ipecacuanha, in association, or in alternation 
with laxative bitters, and repeat it as often, and continue to 
use it as long as possible so as not to induce salivation. 
Whenever ptyalism is threatened, we withdraw the pill and 
trust the bitters without it for a w£ek or two, and then again 
resume the pill. If it too readily induce a salivation, we sub- 
stitute for it the blue pill, and follow the same plan. If a 
cure be practicable, it will be accomplished. 

Hysteria is also, more or less, the effect of diseased viscera. 
Its most prominent symptoms are, wandering pain in the ab- 
domen, flatulence and foetid evacuations, with constipation — 
the certain indications of disorder in the functions of the 
viscera. This is also the opinion of Dr. Hamilton, who says 
" these symptoms afford conclusive evidence, that the gastric 
affection is primary, and that the other multifarious symp- 
toms of hysteria, depend on it. We have therefore thought 
it reasonable, to attend particularly to the state of the stom- 
ach and intestines, and to employ in the first place, purgative 
medicines, to remove the constipation which most commonly 
prevails in hysteria." In this ^sease, however, much more 
decisive purging is necessary than is proper in hypochondri- 
asis ; and it is found beneficial to unite purging medicines 
with the foetid gums. Assafoetida is commonly preferred. 
There is a striking fact which has been noticed by Dr. Ham- 



CATHARTICS. 303 



ilton and o.thers ; that the first purgatives seem on some oc- 
casions to aggravate the symptoms. In a case of that sort, 
it will require address to insure the necessary repetition, and 
the practice must not be deserted on that account. The dis- 
tress which the first dose gives, is owing to the inconven- 
ience of relaxation, and corresponds to the uncomfortable 
sensations which those females feel, who are accustomed to 
tight lacing, when on any account they lay off their corsets. 
!&■ perseverance in the use of cathartics, the intestinal vessels 
will be evacuated; and their natural sensation will be restored. 
After a brisk purge or two, we use small doses of calomel and 
ipecacuanha for a few days. If the pulse rise under the 
agency of this preparation, we let blood, repeat the cathartic 
and then recur to the pill of calomel and ipecacuanha, made 
in the proportion of about one-fifth of a grain each. So soon 
as the patient becomes too susceptible of the mercurial influ- 
ence to bear this combination, we have recourse to the blue 
pill, in small portions, and continue one, two, or three per 
day. 

Dr. Hamilton is the first physician who directed the atten- 
tion of the profession to the use of purgative medicines in 
treating chorea sancti viti. This disease is thought to be 
often dependent on gastric irritation or great foecal accumula- 
tion in the lower intestines ; and of course, whenever such a 
state of things exists, purges in decisive doses, must unques- 
tionably be of very great utility. This practice is sustained 
by very considerable authority, as Sydenham, De Haen and 
Stahl. Dr. Hamilton divides the disease into two stages — 
the first includes all the time, so long as the intestines retain 
their sensibility, and before the accumulation of fasces is 
great. During this stage, he thinks that gentle purges, re- 
peated as occasion may require, will effect a cure, or more 
properly prevent a full formation of the disease. In the se- 
cond, which is, when the disease has become confirmed, a 
more careful attention will be required. Powerful doses 



304 CATHARTICS. 



ought to be given in pretty quick succession, at.intervals so 
short, that the latter dose may support the effect of the for- 
mer, until the expulsion of the accumulated matter shall 
have been effected. But in order to gain permanent advan- 
tage by the practice, it must be pursued in a suitably decis- 
ive manner. "Half measures/' says Dr. Hamilton, " in in- 
stances of this kind, will surely prove unsuccessful." 

But chorea does not always depend upon causes seated in 
the viscera of the abdomen ■ and therefore we find it will not 
s yield to the most complete and efficient course of purgative 
treatment. Indeed, there are frequent instances in which 
evacuation serves obviously to aggravate the disease. All 
such, will be relieved most effectually by the use of the min- 
eral -solution of Fowler, cuprum ammoniacum, iodine or 
moxa applied to the spine. There can be no considerable 
hazard in testing first the effect of Dr. Hamilton's plan, which 
probably in a majority of instances is the most rational me- 
thod of treating the disease. 

In marasmus, purging is the only useful remedy. This 
disease is unquestionably connected with derangement of 
the digestive organs. We are informed by Dr. Hamilton, 
that during the first stage, which extends from its commence- 
ment to the accession of the hectic state, it may be cured by 
mild purgatives. During this first stage, the bowels are not 
altogether torpid, nor are they overloaded with accumulated 
foeces. But after the disease has advanced into the second, 
which is the febrile stage, more active medicines are required, 
which must be regularly and perseveringly employed. Dr. 
Hamilton recommends the exhibition of small, but frequently 
repeated doses of cathartic medicine, so administered, that the 
latter dose may support the effect of the former or preceding 
ones. When the bowels are once opened, then stronger 
doses, given at longer intervals, will accomplish the cure. 

He also recommends the use of purgatives in the treatment 
of chlorosis. "The slightest attention to the history of the 



CATHARTICS. 305 



disease," he says, "evinces, that costiveness precedes and 
accompanies the other symptoms. Costiveness induces the 
fosculent odor of the breath, the disordered stomach, depraved 
appetite, and impaired digestion. These preclude a sufficient 
supply of nourishment, at a period of growth when it is most 
wanted j hence paleness, laxity, naccidity, the nervous symp- 
toms, the wasting of the muscles, languor, debility, the reten- 
tion of the menses, the suspension of the other secretions, 
serous effusions, dropsy and death.'' Inasmuch as all these 
phenomena are the effects of costiveness— suppose we inquire 
what state of things produces the constipation? No doubt, 
a diseased state of the skin and portal circle. The ordinary 
method of treating patients of this description, has been to 
administer tonics, such as iron, wine, bitters, &c. There 
must be good constitutions, when cases of this nature are 
cured by such treatment. Oar experience goes to sustain the 
opinion and practice of Dr. Hamilton, as to the use of ca- 
thartic remedies. His practice is correct, though he does 
not look sufficiently deep into the cause of the disease. In 
cases of this affection, we associate the pill of caloVnel and 
ipecacuanha with the use 6f tonics, if there be any need for 
their use. The pill should be continued so long as any vis- 
ceral disease remains. 

Some females are liable to a vomiting of blood, an affection 
which occurs from the age of eighteen to thirty. The attack 
is preceded by languor, and oppression about the chest, and a 
sense of fullness of the precordia; hiccough, dyspnoea, and 
sometimes pain in the chest, loss of appetite, headache, ver- 
tigo, disturbed sleep; the eye is dull, countenance expressive 
of distress, pulse feeble, bowels constipated — these- are the 
precursors of the hemorrhage; and these indicate a fullness of 
the liver from which the blood in such cases^ is discharged* 
The treatment of course is the same as the preceding. 

No class of medicinal agents admits of more extensive use 
than that of cathartics, in almost every disease and in every 
20 



)06 CATHARTICS. 



part of the known world. Hence it is, that so large a traffic 
in pills, under such an endless variety of names, is carried on 
in Europe and America. Like all other useful things, it is 
often abused. Yet so many find temporary relief and com- 
fort, that the injury done by an injudicious or an ill-timed 
employment of a remedy so universally popular, is seldom 
ascribed to its true cause. It would be a valuable service, if. 
the dangers which follow its abuse, could be made sufficiently 
obvious to secure the necessary caution. This, however, 
will be a hard task, and the more so in this country, when 
there is such an abundant supply of food, and such prevail- 
ing inclination to indulgence. 

Those who take great delight in the luxuries of the table, 
so often need the aid of pills, and are so frequently prepared 
by their use, to return to their "chief joy," that next to the 
pleasures of eating, are the supposed means of sustaining 
their ability to eat. f 

It is a customary thing for epicures, when their health and 
ability to eat and drink with their usual relish begin to fail, 
to visit the springs. The waters are sufficiently medicated, 
when taSfen in liberal quantities, to act freely on the bowels, 
without restraining the appetite for food. The invalid finds 
that he can eat with great satisfaction, and by means of a 
speedy evacuation be ready to repeat his meals more fre- 
quently and indulge more freely than when in health : and 
if the evacuations are frequent and free enough to convey 
away a sufficient portion of the chyle, before the lacteals can 
have time to absorb too much, the waters will probably prove 
really beneficial ; for on this point alone the issue turns, 
whether for benefit or injury. In managing the cases of in- 
valids of this description, we have the greatest difficulty in 
respect to diet. They cannot govern their appetites. Hence 
the best concerted plans are so frequently defeated. In 
treating a case of this kind, therefore, we should never ex- 
pect a rigid regard to prescribed abstemiousness, but adopt 



CATHARTICS. " 307 



measures which will insure the intention without much self- 
denial. We should associate with the intended medicament, 
the daily use of Bedford or Saratoga water, or some artificial 
substitute, to an extent sufficient to imitate the effect of a 
residence at the springs. We often administer to our pa- 
tients, whose livers and other important viscera have been a 
long time sore and languid, one, two or three doses, a day, of 
calomel and ipecacuanha, of each, one-fifth of a grain, and 
associate with this minima pill, frequent repetitions of drachm 
doses of Epsom or Rochelle salt, sufficiently diluted, so as to 
secure at least two evacuations every afternoon. The pill 
will produce the alterative effect, if the system be sufficiently 
deprived of its nourishment, and the salts, diluted with ale 
and water or ginger tea, or water only, may be used to sub- 
stitute the water from the springs. Although the patient may 
be thus indulged, the evacuation of the food so as to rob him 
of his chyle, will serve to put the absorbents in a state of 
requisition, and any existing enlargement or induration of 
the diseased viscus, will be retired. 



308 DIAPHORETICS, 



CHAPTER VIII. 

DIAPHORETICS, 

Medicines which increase the natural transpiration by the 
exhalents of the cuticular surface, we denominate diaphoret- 
ics. When they act so extensively and effectually, as to 
produce sweating, we call them sudorifics ; the term diapho- 
retics is usually associated with such articles as serve more 
particularly to increase the sensible perspiration. 

Much has been written on the subject, of obstructed perspi- 
ration : and the latest and best works, have advanced so far 
only, as to make the distinction which regards " opposite 
states of the system." They have learned that obstructed 
perspiration ••'may depend on, or be connected with a high 
febrile action."' and also, on a " slow and languid circulation." 
This is a considerable step towards the true philosophy of 
diaphoretics, but it falls short of affording all the instruction 
necessary to guide the young physician, in his remedial treat- 
ment in respect to the skin. It is useful to know, that rem- 
edies which are calculated to restore this function when its 
defect or loss is associated with high vascular action, must 
be very different from those, which are calculated to excite 
it when in an opposite state." That, in the former case, our 
diaphoretics must be such as have a direct tendency to lessen 
the action of the heart and arteries, and at the same time pro- 
mote the action of the transpiratory vessels. That cold ab- 
lutions, refrigerants, antimonials and blood-letting, are very 
often directly and manifestly diaphoretic : and when a de- 
iciency of this function is accompanied by a languid cir- 



TflAPffORETICS. 309 



culation, and -a pale, shrivelled, or cold skin, that recourse 
must be had to diaphoretics of a stimulating character. 

These general principles have served as imperfect guides 
in the employment of diaphoretics, and are nearly in consent 
with the physiology and pathology which we have adopted 
in view of the skin. 

After all that has been done thus far, we still have to in- 
quire, what is meant by an obstructed perspiration? and 
what is expected to be accomplished by its restoration? If 
the excitement of the skin be partially suspended, for a short 
time only, the system being in ordinary good health, reac- 
tion will be speedy and agreeable, accompanied by a pleas- 
ant moisture of the skin. This position is exemplified and 
confirmed by what occurs on using the shower bath ; or on 
stepping about a few minutes, without any clothing, in the 
open air. In either case, after being dressed, reaction and 
slight perspiration immediately follow. So also in winter, 
after exposure for a considerable length of time, by the aid 
of fire in the usual way, a similar state of things readily oc- 
curs. For this alternation of suspension and reaction of ex- 
citement, the skin seems to have been particularly and em- 
phatically destined. A suspension of the circulation, such as 
is produced by exposure to cold, when it befalls a person in 
good health, at first induces a stricture of the capillaries of 
the skin. This stricture is consequent on an accumulation 
of vitality. When the capillaries of the skin are filled with 
blood, the excitement which includes the circulation and 
concomitance of all its functions, gives full employment for 
all the vital influences pertaining to that structure. Where 
a sedative power abates the excitement of the capillaries, the 
unemployed sensorial influence fastens on the fibre of the ves- 
sels emptied of their fluids, producing the spastic-condition 
observed by Cullen, which we take the liberty to designate 
by the term, stricture, to distinguish it from the condition 



310 DIAPHORETICS. 



consequent on the evanescence of the sensorial influence, when 
the capillaries fall into a state of collapse. If the exposure 
be too long continued, the stricture will retire, and the skin 
will become collapsed by reason of such evanescence of its vi- 
tality. We stated in our elements, that the suspension of 
excitement is accompanied, through a limited period, by a 
corresponding accumulation of sensorial influence, and that 
when there is an ordinary degree of vigor, this accumulation 
will eventually induce a spontaneous reaction. If circum- 
stances be favorable in regard to time, temperature, &c, the 
reaction will be limited mainly to an increased excitement of 
the skin. If circumstances thus favorable to an adjustment, 
through the medium of the skin, do not concur in time, and 
a stricture takes place on the surface, the reaction maybe di- 
rected to other determinations ; it may produce a more gen- 
eral effort, and excite the heart and arteries. If then the pul- 
monary vessels be overstrained by this effort, it may produce 
an instance of pulmonitis. If the abdominal vessels give 
way, we will have enteritis. If the blood-vessels of all the 
viscera maintain their integrity, after a struggle sufficient 
to expend the accumulated sensorial influence, eventually 
the excitement of the skin will be restored, and a free per- 
spiration follows in the train. But all these statements are 
made in view of a healthful condition of the viscera. 

When the circulation of the cuticular surface is suspend- 
ed, the blood must find place in a distention of the vessels of 
the abdominal and other viscera. A diurnal influx and re- 
flux from the cuticular surface of the viscera, if not strictly 
natural, is universally habitual, and justifies the conclusion, 
that the blood-vessels of the abdominal viscera, are prepared 
by a suitable organism, to admit of the influx, and suffer it 
for a certain length of time without injury. This occurs un- 
der ordinary circumstances during the night, and if not too 
much exposed to cold when we sleep, or if not too long ex- 



DIAPHORETICS. 311 



posed to cold or wet weather at any one time, or if not too 
frequently repeated. Each instance of influx or introversion, 
will be spontaneously corrected by the reflux or reaction, 
which, on the return of morning, upon taking exercise or re- 
freshment, or on returning to the fire after exposure, is con- 
tinually experienced by persons in ordinary good health. If 
this spontaneous reaction should not take place in the usual 
manner, and the blood be thus accumulated, and too long 
delayed in the vessels of the abdominal viscera, a stricture of 
the cutaneous blood-vessels will be an inevitable consequence, 
which will be accompanied with head-ache, chilliness, list- 
lessness, stiffness of the limbs, and sometimes with nausea, 
thirst and wandering pains. In every such instance, it is ne- 
cessary to have a proper regard to the state of the viscera, in 
making an estimate as to the probability of a spontaneous 
reaction of the cutaneous vessels. If the general circulation 
be not materially impeded by plethora, and no one viscus is 
in a state of congestion, bathing the patient's feet in hot wa- 
ter, giving him a cup or two of hot tea, and covering him 
warmly in bed, will be effectual in correcting the stricture, 
and in re-establishing the cutaneous circulation, that is, "re- 
storing the circulation." 

In any instance, however, in which there is considerable 
plethora, or the blood-vessels of the viscera have been in a 
state of distention until their tone is too much impaired to 
consent with the arrangement intended to favor centrifugal 
action, or when any one of the viscera is in a state of 
congestion, neither pediluvium, nor hot drinks, nor retir- 
ing to bed. nor the agency of any stimulating or diapho- 
retic medicine, will be efficacious in correcting the stricture. 
In consequence of the plethora, the blood is not in a state of 
complete assimilation ; it is deficient in respect to all the in- 
fluences derived from a free circulation through the lungs and 
skin. A considerable portion of effete matter is retained in> 



312 DIAPHORETICS. 



consequence of its languid circulation through the secreting 
organs, causing these also to languish. Moreover, because 
of the imperfect state of the blood, the condition of the sen- 
sorium, the nerves, and all the viscera is continually growing 
worse. In every such case the system must be released from 
its thraldom by the necessary depletion, before any diapho- 
retic agent can be made to take effect. But after the neces- 
sary blood-letting and purging, in a majority of instances, 
any agreeable stimulant drink, if taken insufficient quantity, 
will be followed by a pleasant diaphoresis. Under such cir- 
cumstances, the heart and arteries readily command the re- 
maining volume of fluids ; the viscera, lightened of their ex- 
cessive load, perform their functions well ; the blood again 
becomes charged with its vivifying principles, and is propel- 
led freely to the surface ; and if the correction be made in 
time, the skin by its sui generis action will admit, and circu- 
late its portion, which will be evinced by a return of perspi- 
ration. If the case have been attended with some delay, in 
addition to the requisite depletion, it may be necessary to 
make appropriate application of external heat, and adminis- 
ter internally some diaphoretic agent, calculated to favor 
a determination of the circulation to the capillary vessels 
of the skin, without materially augmenting the action of 
the heart and arteries. In instances of this sort, we pro- 
cure the most perfect exhibitions of diaphoresis. 

When the cutaneous vessels have been long in a state 
nearly destitute of circulation, such as subjects the nerves to 
a condition approximating to torpor, which is always accom- 
panied by'a collapsed state of the skin, there will be much 
additional difficulty. Some congestion of the viscera will 
be found to have previously existed, so long, that the blood 
will be more or less deteriorated. There will be found to 
exist a corresponding degree of general debility, such as 'for 
£he time will forbid blood-letting, or much depletion in any 



DIAPHORETICS. 313 



way. In such a case, a potent stimulant would probably en- 
danger the congested viscus, and a mild diaphoretic would 
not be sufficient to recover the circulation of the cutaneous 
vessels. There will be occasion therefore, to employ a train 
of preparatory measures. The bowels must be evacuated 
according to the strength of the patient, external heat must be 
used in a manner having respect to the time of continuance, 
which will probably be required to accomplish the intention ; 
then some appropriate diaphoretic drink must be adminis- 
tered, as an infusion of Serpentaria Virginiana, &c. adding 
when necessary, spiritus mendreri, wine whey, &c. &c* 

By this treatment, it is probable, that a part of the excess 
of blood' detained in the veins of the viscera, will be trans- 
ferred into the arteries, and may possibly produce a degree of 
tone in the arterial action, which should be corrected by 
blood-letting ; and this is always a favorable occurrence 
whenever it takes place, inasmuch as it reports an improve- 
ment in the condition of the veins, and of the nerves de- 
pendent on the circulation through the capillary vessels of 
the surface. 

If this occurrence should take place whilst the patient is 
under the influence of diaphoretic remedies, or at any time 
after the intention may be considered to have been accom- 
plished, it is as necessary to correct the tension of the arteri- 
al action by depletion, as if no appearance of debility had oc- 
curred in the first instance. A condition of things corres- 
ponding to that which is presented in an instance of this kind 
sometimes occurs spontaneously. 

An elderly lady, say fifty years of age, who had for a long 
time been subject to cough, without appetite for food, having 
head-ache, some unnatural thirst, confined bowels, and a good 
deal of the time being unable to sit up long at once, having 

* The foregoing paragraph describes the condition of the^ system when 
predisposed for an attack of typhoid fever. 



314 



DIAPHORETICS. 



occasionally made use of gentle laxatives, at considerable in- 
tervals ; at length, rather unexpectedly, felt so much better 
that in the evening of the same day, after having sent for us 
in the morning, she declined any medical attention, believ- 
ing she was so much improved as to need no prescription. 
She was sitting up, but there was a livid paleness of complec- 
tion, and a peculiar feebleness of the arterial action, without 
frequency or discoverable tension, which led us to apprehend 
that she would be disappointed. We were the more appre- 
hensive, because her respiration was somewhat restricted, al- 
though an attempt at a full respiration gave no sensible in- 
convenience. We did not think her convalescent, but were 
informed that if things should not progress agreeably to her 
expectation, she would let us hear from her. The follow- 
ing day, she still considered herself to be doing well, having 
had, on the whole, an agreeable night. The second day she 
was disposed to take nourishment, but whilst in the act of 
eating dinner, was suddenly taken with a violent chill, like 
the onset of pneumonitis, followed very quickly by an excru- 
ciating pain in the breast, great difficulty in breathing, insa- 
tiate thirst, 4*c. Being sent for in haste, we reached her in the 
evening and found her very ill. Her case was now obvious- 
ly inflammatory, requiring blood-letting, which was repeated 
daily for two days, in each instance affording great comfort. 
When the violence of the inflammatory action was subdued, 
the case was marked with considerable debility, on account 
of which, after each blood-letting, heated bricks wrapped in 
napkins and moistened with vinegar, were applied to her 
feet and knees ; and several times exchanged, so as to main- 
tain the temperature ten or twelve hours. After the first 
bleeding, a large epispastic, ten by twelve inches, was appli- 
ed over the epigastric and hypochondriac regions — spiritus 
mendereri and oxymell of squill were administered through 
the day, to which were added a little camphorated tincture 



DIAPHORETICS. 315 



of opium, and nitrous ether, through the night. The case 
progressed very comfortably, but the disposition to phthisis, 
pulmonalis still prevailed without improvement. 

Had there been less sensorial activity in this case, the in- 
flammatory attack could not have occurred. Similar appear- 
ances in autumn, and with sound lungs, probably would 
have eventuated in fever. It was winter; and although the 
circulation of the cutaneous blood-vessels was languid, 
the sensorial influence was gradually accumulated, until 
the system was charged for a spontaneous reaction. — 
In the mean time, the stricture of the cutaneous vessels, 
which were bordering on the state of collapse, prevented a 
free and general distribution of the circulation, in consequence 
of which, the pulmonary arteries were subjected to a very 
alarming morbid action. 

In collating this case with those in which apparent debility 
under the influence of a stimulant diaphoretic treatment, is 
abruptly followed by inflammatory appearances, it is neces- 
sary to invite attention to the following particulars. The 
accumulated and apparent latent vitality in the case referred 
to above, is roused by means of artificial excitants, made the 
more stimulant by the concomitant employment of heat. In 
this case a similar accumulation existed, and was permitted 
to progress, till the natural or ordinary stimuli were sufficient 
to rouse the system to a spontaneous reaction, so strong as to 
produce violent symptoms like pulmonitis. It is not a com- 
mon occurrence, that the system, when fallen into the state 
of a collapsed surface, will be so roused by a course of dia- 
phoretic management, as to require blood-letting. Cases like 
that just now described, are also rare ; whenever either of the 
circumstances does occur, it will be found useful to treat the 
patient according to the plan of practice above stated. 
When cases become chronic, and especially when some or- 
ganic disorder has taken place, and when it has become ne- 



316 DIAPHORETICS. 



cessary to introduce an alterative plan of treatment, a healthy 
condition of the cuticular surface cannot be hastily establish- 
ed — in fact too great an effort to establish it hastily, at any 
one time might prove injurious. 

u Diaphoretics," says Dr. Eberle, u may act by relaxing the 
mouths ofihe perspiratory vessels, or by increasing their ac- 
tivity, or by establishing their increased activity, or by ef- 
fecting an increased flow of blood into them, or by producing 
these two last mentioned effects simultaneously." When 
the blood has been for some time turned too heavily upon 
the viscera, and has become deteriorated, not only by reason 
of the imperfect performance of the functions of the organs 
which have been thus overcharged, but also by the detention 
of the morbific particles, which ought to have been thrown 
out by perspiration, it is very obvious, that in addition to the 
restoration of the excitement of the skin, it is necessary that 
a state of perspiration should be kept up for some time. In 
cases of established fever, such as require much depletion, it 
has been customary for the physician to be satisfied with the 
diaphoretic effects of antimony ; on the supposition that much 
advantage is gained from the evaporation of the morbid heat, 
which is a considerable source of irritation. 

Sudorifics have been among the earliest and most com- 
mon remedies in every nation. But valuable as they are, 
and extensively as they have been used, there is perhaps no 
other class of medicines, which has been so often abused in 
the treatment of sickness. Van Helmont and his followers 
who believed that the most acute diseases were cured by ex- 
pelling some morbific matter, after " its proper concoction," 
employed the most stimulating sudorifics, together with high 
temperature in every grade of febrile exacerbation. This 
practice appears to have prevailed during the seventeenth, 
and the early part of the eighteenth century ; and it is easy 
to perceive, that its effects must very frequently have been 



DIAPHORETICS. 317 



pernicious. More than one hundred years ago, a certain 
German physician made use of -an apparatus for applying 
heated air by means of ignited alcohol. He used it exclu- 
sively, however, for the cure of syphilis. For several [days 
he poured in enormous quantities of guiacum, .^c, and then 
applied the heated air to sweat out the fluid, and with it the 
syphilitic virus. . His practice was altogether empyrical, and 
would now be justly considered unworthy of the profession. 

But it must not; be concealed, that many worthy physicians 
think. the same of the employment of external heat in the 
treatment of fever. The utility or perniciousness of an at- 
tempt to produce a profuse diaphoresis- in acute diseases, de- 
pends on the means that are used to excite it. The employ- 
ment of heating or stimulating remedies, internally for this 
purpose, renders the practice injurious ; whereas, if we elicit 
perspiration by cool applications, or by the use of diapho- 
retics of the refrigerent kind, we in general derive unequivo- 
cal advantage from it. 

The opinions generally entertained, in respect to the ap- 
plication of external heat, are greatly erroneous. Facts are 
stubborn things. We have hundreds of times applied heat- 
ed air to persons affected with acute disease. But almost in, 
every instance we have found it necessary to prepare the pa- 
tient for the application of heat by blood-letting, which was. 
often followed by a cathartic. We have used it in pleurisy, 
catarrh, pulmonitis, dysentery, enteritis, rheumatism, gout, 
bilious fever, erysipelas, opthalmia, diarrhoea, measles, small 
pox, and in almost every disease commonly met within this 
climate; yet, never have had occasion to consider its' effects 
injurious, when introduced under suitable circumstances. 

We have used it in a case of protracted parturition^ when 
the patient was exhausted by struggling for the birth of a 
dead foetus, whose cranium was two inches larger than the 
long diameter of the pelvis. Her pains had ceased through 
exhaustion. By the instrumentality of our vapor hath, and, 



318 DIAPHORETICS. 



a moderate quantity of cordial drink, in the course of an hour 
she was rallied ; her pains returned, she was delivered by 
means of the crotchet, and had a very favorable convalesence. 
We have used it with unequivocal advantage in a case of 
alarming anthrax. The carbuncle was seated midway be- 
tween the neck and hips, over the spine ; and the patient 
was more than seventy years of age. It was followed by a 
very natural sloughing, and an exceedingly pleasant recovery. 

We have used it in a case of occult character, thought to 
be the commencement of a bilious fever, the system being in 
a state of depression. By the agency of heat, the circulation 
was resuscitated, after which the patient was freely bled, and 
on the following day there appeared a very satisfactory dis- 
play of distinct small pox, which progressed with regularity 
and terminated in health, without leaving the patient offen- 
sively marked. We have used it in a case apparently like 
the one last mentioned, which proved to be measles ; and 
which in like manner was displayed after blood-letting. 
This case progressed and terminated in a manner equally sat- 
isfactory. 

In view of the theories which we are endeavoring to com- 
municate, the use of this remedy is entirely philosophical ; 
in fact it corresponds with Dr. Eberle's views. " When the 
body is exposed to cold," he says, " the circulation in the 
subcutaneous vessels is immediately and manifestly dimin- 
ished, both in velocity and volume ; and the skin becomes 
pale, shrunk and cold. As a natural and necessary result of 
this condition of the circulation on the surface, the blood is 
repelled to the intestinal vessels, and much of the excremen- 
titious fluids, which nature intends and the welfare of the 
system requires to be cast off by the skin, is retained in the 
system. There is, therefore, under these circumstances, a 
superabundant portion of deteriorated blood forced upon the 
heart, which acting upon it as a preternatural stimulus, brings 
on, sooner or later, reaction, or the stage of febrile excite- 



DIAPHORETICS. 319 



ment." The whole of these facts are in accordance with our 
theory. " Cold," says Dr. Eberie, " obstructs perspiration." 
Heat, we say, corrects the evil, and restores perspiration. 
" The subcutaneous circulation," says Dr. E., " is diminished 
in velocity and volume." Heat, we say, corrects this evil in 
both respects ; the pale skin is made florid; the shrunken 
skin is filled and expanded ; the cold skin is warmed. "The 
excrementitious fluid," says Dr. Eberie, "is retained, and the 
blood is deteriorated." Heat, we say, insures a perspiration 
so copious as to effect the elimination of all offending fluids. 

The opinions which we held and published forty years 
ago on the subject of diaphoretics, we have not materially 
changed. We then believed that they ought to be used 
when the intention is to restore excitement to the surface, 
the system being placed in a condition in which it may safely 
be subjected to the agency of an artificial stimulant. 

When in a state of direct debility, almost any pleasant 
stimulant, especially if it be aided by the application of exter- 
nal heat, will produce an increase of the capillary action, 
which will extend its influence throughout the cuticular sur- 
face, and of course produce perspiration. A sweat forced 
upon a system full of blood and of vital energy, may produce 
morbid effects, and if much fever be present at the time, it 
must be unsafe ; if there be congestions, they may be ren- 
dered more extensive and obstinate." Diaphoretic medi- 
cines, therefore, ought to be used with great circumspection, 
with the intention to elevate the excitement of the capilla- 
ries of the skin and to establish a new action. If this inten- 
tion be judiciously conducted in the forming stage of disease, 
it is frequently effectual in arresting it at once. Yery great 
accuracy of judgment, however, is necessary to guard against 
mistake. Therefore heavy sweats ought never to be at- 
tempted, except by the hand of experience. 

In view of the use of internal diaphoretic agents, our expe- 
rience accords with that of all other experienced physicians. 



320 DIAPHORETICS* 



We have not been able to detect any material error, in their 
opinions or practice, in respect of these. 

Antimony has commonly been considered an important 
diaphoretic agent. For forty years we have used it, as a 
remedy requiring special consideration. At the same time 
that it affects the exhalents of the skin, it very materially 
checks on the sensorial powers. Hence antimonials are most 
useful in fever strongly marked with vital energy, and for the 
same reason, they are always injurious when there is great 
prostration ; when instead of diaphoresis, they are apt to pro- 
duce colliquative diarrhoea. The moisture brought out by 
the agency of antimony, is analagous to that which takes 
place after blood-letting whilst the system is languishing and 
inclined to fall into the state of deliquium. 

The perspiration which takes place towards the close of a 
paroxysm of intermittent fever, differs from this, especially 
on its first exacerbations, in which, there is an obvious in- 
crease of the excitement of the skin, presenting a state inter- 
mediate between the perspiration of the harvest field and 
that produced by antimony. 

The sweat which closes an exacerbation of hectic fever, 
differs from that of the intermittent. In the hectic, there is 
no obvious increase of excitement in the skin. It accords 
more fully with the diaphoresis from antimony, except, that 
the system is much more exhausted, so that the absorbents 
for the time, seem to be quite inactive, whilst the exhalents 
are relaxed, permitting the fluids to run off in great and de- 
bilitating quantities. 

The diaphoresis which we should attempt to establish in 
any recent case, and whilst the energies of the system are 
yet existing in ordinary amount, should differ from all the 
three above mentioned. It ought as nearly as may be to cor- 
respond to the sweat of a healthy laborer — of a blacksmith 
smiting the heated iron on his anvil. The skin is then ex- 
cited ; its vessels are filled, with blood; the respiratory or- 



DIAPHORETICS. 321 



gans are well animated, and they perform their functions in 
full amount ; so that when the system is permitted to rest, it 
returns to a proper state of orderly quietude, and the disposi- 
tion to disease disappears. 

Any of the former instances of apparent perspiration may 
take place, whilst the vessels of the skin are imperfectly 
filled, and its action very deficient. The case of the black- 
smith draws one line of demarkation — the sweat of death the 
other. Between these two lines, we have all the possible 
degrees of difference of which the state of perspiration is sus- 
ceptible. 



2ft 



322 DIAPHORETICS. 



CHAPTER IX. 

DIAPHORETICS— CONTINUED. 

When the system has been long in a state of debility, of 
that sort which obtains in chronic diarrhoea, &c. a species of 
injury is effected, which so far as we have yet learned, re- 
mained unnoticed till the year 1810, when the application of 
heat after the manner in which we recommend it, ]ed us to a 
consideration of the subject. It is known, that the system in 
its powers for adaptation, ultimately adjusts the circulation of 
the whole stream of arterial blood, which is sent into an am- 
putated limb, although deprived of all the ramifications of the 
arteries and veins, below the line of separation. It is known 
also that the lesser branches of the arteries become sufficiently 
capacious to supply the absence of a trunk which may have 
been divided by the operation for aneurism. There can be 
no reason therefore to doubt, that the arterial blood, naturally 
destined to support the skin and undergo the functional 
agency of that structure, when excluded by a partial collapse 
of long standing, will ultimately find a return : and an en- 
largement of the calibre of the vessels, engaged for this pur- 
pose, will render the return so easy, that afterwards, the ca- 
pillary circulation may never be sufficient to convey the blood 
in sufficient volume to the surface so as to effect the restora- 
tion of the functions of the skin. Hence the necessity of 
every possible aid to promote an easy, free and continued ex- 
citement of the cuticular surface not only in cases of chronic 
diarrhoea, but also and in like manner, in all chronic disease : 



DIAPHORETICS. 323 



since it is probable, that the same thing occurs in a greater 
or lesser degree, in all cases of long standing debility.* 

It may be thought, perhaps, that a frequent application of 
heat for the correction of such an error, may induce an in- 
crease of debility; but this is an unfounded appehension. An. 
excessive sweat under such circumstances would be perni- 
cious, and sooner or later, if persisted in, would necessarily 
destroy the patient. But an appropriate application of heat, 
supported by the proper auxiliaries, invariably has the oppo- 
site effect. If well conducted, the practice gives expansion 
to the vessels of the cuticular surface, the blood finds admis- 
sion, bringing with it new life. By the aid of friction, the 
excitement may be maintained for a longer or a shorter time, 
when heat again becomes necessary. At length the circula- 
tion of the skin is established. It is to be understood, that in 
this view, it is supposed that all the while a proper attention 
shall, have been paid to the condition of the viscera • and al- 
terative, astringent, or tonic, or cordial remedies, have been 
employed, according to the existing demands of the case. 

In any instance in which there may be an extensive con- 
gestion, the same considerations which would interdict a 
very copious blood-letting, would also forbid a very profuse 
or long continued sweat. There is a difference in favor of 
the use of heat, wfeich we must notice in this place. The 
vessels, involved in a congested and almost lifeless mass, if 
subjected to a suspension of action for any considerable 
length of time, or to too great a diminution of action, which 
is more or less the necessary result of considerable blood-let- 
ting, a gangrene of the congested structures might speedily 
be induced. Too great an abstraction by a very copious 



* In consequence of the facts here stated, we find that persons having 
become acclimated to a very sickly location, as also, such as have long la- 
bored under chronic visceral disease, are always pale and their skins are 
peculiarly poor and thin. All these, have by habit become able to live, the 
skin having almost become destitute of its circulation and functions. 



>24 DIAPHORETICS, 



sweat might produce a similar effect. But a judicious appli- 
cation of heat, by rendering the blood more fluid, of course 
by improving its condition, through a more effectual agency 
of the blood-making and blood-repairing organs, the condition 
of the congested vessels is improved, and they are sooner in 
a readiness to perform the functions of absorption. 

In applying heat, the whole cuticular surface should be 
brought at once under its influence,, in all eases when the 
system is in a state to admit of it; that is, in all cases which 
would admit of blood-letting : when there is too much debil- 
ity for this, the application should commonly be confined, at 
first to the lower extremities. In recent instances, generally, 
whether blood-letting is necessary or not, the application 
may be made to the whole cuticular surface. In all. such 
cases, the vapor bath, or heated atmospheric air, is the most 
convenient medium of application. 

Sufficient experiments have established the fact, that the 
naked human skin can safely be subjected to a temperature 
hot enough to roast beef or bake bread, if the heat be dry, 
like the atmosphere of a heated room, and the subject of ex- 
periment may safely remain in a room so heated, long 
enough to cook a beef steak. Whereas the steam of boiling 
water, will in a few seconds inflict a mortal scald. The va- 
por bath, which will be described in the ^quel, generates a 
dry heat, or more properly it heats a portion of atmospheric 
air and conveys it into the cavity provided by a suitable ap- 
paratus : so that the patient is heated, lying comfortably in 
bed, and the treatment can be safely continued until it pro- 
duce the intended effect. 

In doubtful cases, as also in cases of known debility with 
considerable emaciation, the application ought to be partial 
and is best made by applying jugs of hot water, or heated 
bricks ; a leaden or copper vessel of convenient shape, would 
f&mi a very desirable family contrivance. The temperature 



DIAPHORETICS. 325 



of this maybe regulated by the water with which it is, filled, 
which may be more or less hot according to circumstances. 

In the commencement of fever, the vapor bath should be 
preferred, and it may always be used with decision, so as to 
produce profuse sweating. So soon as the sweating is fully 
established, the further application of heat is unnecessary; 
commonly, however, it is best to prepare the patient by 
blood-letting. 

It happens sometimes in recent instances, when there is 
pain in the breast or bowels, and when the propriety of 
blood-letting may be doubtful, that the application of heat 
may produce partial sweating and temporary ease ; but unex- 
pectedly, the perspiration dries up, the pain increases, and 
not unfrequently the patient feels considerable distress and 
oppression.* Such" an occurrence at once reports the neces- 
sity of speedy and decisive blood-letting. After the deple- 
tion, the sweating process will go on very pleasantly, and 
produce the happiest result. 

In some instances, when the system is tending to a state 
of congestion, and heat is applied, by whatever means, if the 
requisite blood-letting has been omitted, the heat will pro- 
duce distressing restlessness and anxiety, as if the atmos- 
phere needed oxygen, or the room needed ventilation ; in 
such an instance there will commonly be an accompanying 
headache. Whenever the application of heat seems to pro- 
duce these symptoms, blood-letting is necessary, after which 
a cathartic should be administered, because in almost all such 
cases, the blood-vessels of the viscera are in a state of unna- 
tural fullness. 

Heat can scarcely be applied with the necessary decision 
without producing some sense of throbbing in the head. The 

# Physicians and others not well informed on this point, on meeting- such 
an occurrence, have concluded at once that the vapor bath is a pernicious 
agent and have laid it aside, condemned as being* unsafe and worthless. 
The truth is, they were ignorant in respect of the condition of the patient 



326 



DIAPHORETICS. 



occurrence of this symptom is indicative of a sufficiency of 
the application at any one time ; and if the system is in a 
state in which it is able to effect the necessary adjustments, 
on the retirement of the heat the throbbing will speedily sub- 
side, leaving no inconvenience to the patient ; if not, it will 
be corrected by blood-letting. At this stage of the treatment, 
it is always comfortable and generally beneficial to the pa- 
tient, to take a good drink of cold water. 

In treating very feeble patients, it is the better way, not to 
continue the application quite far enough to produce the 
throbbing. It is more agreeable and safer, to take more time 
and let the heated air, &c. be applied and retired alternately, 
as it may be found to suit the case. 

When the patient is feeble and aged, we should keep a 
constant application of a jug of hot water to his feet, and 
extend the application and vary it, according to circumstan- 
ces, by using hot bricks wrapped in cloths, moistened with 
vinegar, &c. 

It is often useful, sometimes necessary, to vary the appli- 
cation so as to alternate it between the feet and the sides, or 
abdomen, &c. the value and manner of which, the physician's 
own judgment and experience will enable him to perceive 
and manage, according to the emergencies of the case. 

Sometimes in instances of recent debility, and almost al- 
ways in those of long standing, a considerable application of 
heat can scarcely be set fully in operation, before the patient 
will complain of great sickness or sense of faintness. When 
either of these occur, let the application be retired for a lit- 
tle, and administer a glass of good old wine and water. So 
soon as the patient seems refreshed, renew the application. 
If after all, the heat should seem insufferable, apply a blister, 
and continue the jug of hot water only. The following day. 
resume the practice, and if necessary, repeat the wine and 
water. By proceeding cautiously and gradually, after some 
days, the patient will bear an intense heat and a longer dura- 



DIAPHORETICS. 327 



tion of its application with less anxiety. The distress in 
such cases, is the inconvenience which is felt by the heart 
and central vessels, consequent on inviting the blood to the 
surface. The sense of faintness, is analagous to what would 
be felt, if a patient in similar circumstances, were improperly 
treated with blood-letting. In instances such as these, it is 
often necessary to use Hoffman's anodyne, vitriolic ether, or 
tincture of opium, in aid of the wine and water — ten, fifteen 
or twenty, sometimes thirty drops, to be administered about 
the time the effect of the external heat becomes fully evi- 
dent. The intention of the tincture of opium is to maintain 
the excitement long enough, to give - permanence to the ac- 
tion of the capillary vessels of the skin, and prevent a col- 
lapse of the surface, which would be apt to follow the treat- 
ment, if this precaution should chance to be omitted. By 
this sort of address and management, we have often recovered 
our patients out of the most deplorable condition. 

In almost any case of long standing, as also in cases where 
blood-letting has been repeated three or more times, if heat 
be used as we recommend it, it is necessary after the bath to 
use a jug or bottle of hot water, or a sufficient number of hot 
bricks, to be exchanged as often as they begin to cool, to aid 
the feeble excitement of the cuticular surface long enough to 
resuscitate the vitality of the skin. 

Having premised these general observations on the agency 
of heat, as a diaphoretic, or a remedy for the special treat- 
ment of the skin ; we will submit some additional remarks 
respecting its use, in particular instances of disease — and first 
for the correction of the circumstances and appearances 
which commonly precede pleurisy, rheumatism, quinzy, &c. 

After exposure to cold or. wet weather a certain length of 
time, the system will express more or less a disposition to ir- 
ritation, which will be evinced by headache and a sense of 
fullness, particularly, an apparent stuffing of the nostrils so as 
to impede respiration, and a disposition to chilliness. When 



328 DIAPHORETICS. 



these symptoms occur, cider, wine and ardent spirit should 
be avoided. But before going to bed, special pains should 
be taken to establish the excitement of the surface. If ordi- 
nary measures fail to produce this effect : if an unusual length 
of time pass away, without becoming warm in bed, it may 
be taken for granted, that the skin has become constricted 
and the blood-vessels of the viscera distended : and unless 
those vessels are unloaded either by exciting the skin or by 
blood-letting, an attack of fever may be confidently expected. 
If a disposition to stretch and yawn, with a dull and heavy 
pain in the loins and a chill be felt ; it may be considered 
the commencement of a paroxysm of fever. A patient in 
such a condition, by retiring to bed and taking an intensely 
hot bath, will be immediately relieved. The expansion of 
the skin makes room for the circulation, and the blood- 
making viscera with the aid of their several emunctories, are 
enabled to get off the load. If, however, any of the indica- 
tions before stated should occur, calling for blood-letting and 
catharsis, these additional measures, of course, are to be 
taken, and the patient will almost invariably escape the 
threatened attack. 

It is commonly thought, that the application of heat to a 
patient when actually attacked with pleurisy or inflammatory 
rheumatism, would be injurious. We are prepared to say, 
that this is an error. The reverse is true. After letting 
blood, the hot bath may be applied with advantage. In 
some instances it may seem to increase the pain, but it like- 
wise affords an opportunity to repeat the blood-letting within 
a shorter time, by reason of the stability which it gives to the 
excitement of the capillaries, and of course to the action of 
the absorbents. In treating a patient with external heat in 
a pleurisy, the application should be intense ; the greater the 
pain and the more violent the action of the heart and arte- 
ries, the more intense should be the degree of heat employed 
in the case. By letting blood the arterial action is sunt- 



DIAPHORETICS. 329 



ciently reduced to protect the head and the lungs ; and the 
excitement enforced on the surface by the agency of heat, 
brings into use the sensorial influence in a manner corres- 
ponding to the intention with which we administer an emetic 
after blood-letting in similar cases. By the auxiliary opera- 
tion of one or more gentle cathartics, and the continued use 
of a little antimony, the sensorial influence is diverted from 
the point of internal irritation, and is fully employed in meet- 
ing the increased demands of the skin. So long as the action 
of the skin can be maintained by this kind of management, 
there is no need of applying a blister. But if it begin to fail, 
recourse must then be had to epispastics, which must be suf- 
ficiently extensive to take command of the system. 

It was formerly the practice, in this disease, to let blood 
without taking adequate measures to disarm the system 
of its accumulated sensorial influence; the consequence was, 
that hemorrhagic reaction made additional bleedings ne- 
cessary. But we shall have occasion to extend this inves- 
tigation, when we shall submit our views on the subject of 
epispastics. 

Under similar circumstances and appearances, the same 
kind of practice is equally proper, without regard to the name 
of the disease. 

In rheumatism, particularly in its inflammatory form, the 
application of heat requires some special considerations. The 
arterial action is ordinarily too strong, and one or more blood- 
lettings are necessary. After letting blood once, twice, or 
three times, unless special care be taken, the excitement of 
the skin will falter. If this be overlooked, the power which 
ought to be expended on the skin, will determine on the 
parts which are in a state of irritation in consequence of the 
rheumatic action. Hence the external application of sina- 
pisms or epispastics, becomes imperiously necessary, and it 
must be repeated again and again, according to circumstances. 



330 DIAPHORETICS. 



At length however, although the skin may be excoriated to 
a considerable extent, still it fails in its action. This failure 
comes on gradually, because the strength of the circulation 
gradually subsides. If the action of the skin sui generis, 
depended exclusively on the power of the nervous system, 
abstractly from the concurring influence of the circulation, 
irritation alone ought to be sufficient to maintain the action 
of the skin. But it will fail, and not a few of the chronic 
instances of the disease become unmanageable in consequence 
of this circumstance. The nervous influence which ought 
to be continually employed id maintaining the action of the 
skin, becomes permanently expended in maintaining the 
rheumatic action. When sinapisms and epispastics begin to 
fail in overruling the pain, then is the time when the gene- 
ral application of heat is called for. The sinapisms and blis- 
ters may excoriate, but the effect speedily passes away, be- 
cause of the absence or retirement of the blood. The want 
of sensorial influence which the presence of the blood ^sup- 
plies to the nerves of the skin, so weakens their power, that 
although they be irritated with rubefacients, they are not 
able to maintain the excitement to the necessary amount. 
But if the aid of heat be employed, and repeated, and con- 
tinued, as the case may require, in the course of a few days, 
the condition of the skin will be corrected by the presence 
of the blood so long maintained in it, and its excitement again 
established. 

As these remarks are not merely applicable to cases of 
rheumatism, but are equally true in all corresponding circum- 
stances, they may serve to regulate the practice in all chronic 
cases of rheumatism, gout, dysentery, &c. &c. Perhaps we 
ought to say, that cases of phthisis pulmonalis, and instan- 
ces of marasmus, should be excepted ; inasmuch as such pa- 
tients cannot well sustain the amount of change produced in 
this way in so short a time. Such cases are better treated 
with friction, aided by jugs of hot water, hot bricks, &c. &c 



DIAPHORETICS. 331 



In dysentery, the practice may be employed to the best ad- 
vantage, especially if called early to the patient. In cases of 
this affection, it would often be best to commence with the 
application of heat. If blood-letting ought to be employed, 
when at the same time the symptoms indicating depletion 
are doubtful, the action of heat will make them obvious. 
After this application, with or without the aid of blood-let- 
ting, we proceed to evacuate the stomach and bowels with 
great decision, taking care to insure a continuance of the ex- 
citement of the skin ; and commonly in one, two, or three 
days, this method will put an end to the disease. If, how- 
ever, the case have been -neglected, and shall have become 
chronic — if in consequence of delay the blood making or- 
gans shall have been seriously impaired, then the decision 
which this practice implies, may be too great. In such ca- 
ses, a gentle diaphoresis should be maintained by the use of 
epispatics, hot jugs or bricks, with a view to sustain the 
excitement of the skin, at the same time that the necessary 
evacuations of the bowels by the agency of alteratives are 
going on ; and in protracted cases, after debility obtains, the 
necessary tonics and astringents are to be employed. 

In cholera morbus, this practice is most effectual ; and is 
delightful to the patient. In this disease, there is the most 
alarming desertion of the cuticular surface, accompanied by 
a corresponding determination of fluids upon the intestines. 
We have stated in another chapter, that this disease is not 
exclusively the effect of cold ; that the predisposition is com- 
monly consequent oma gorged condition of the blood-making 
organs ; and that therefore further depletion is generally re- 
quired, after the alarming symptoms are allayed, notwith- 
standing that in time of its violence, there is such obvious 
danger of destruction by too much evacuation. The com- 
mon practice is to administer large doses of tinct. opii, which 
is often necessary ; and we have associated with the use of 



DIAPHORETICS. 



this agent, free draughts of very hot but weak spirit and wa- 
ter. The intention of each and of both together, is to arrest 
the morbid determination, recover the superficial excitement, 
and establish it, and so prevent a recurrence of the introver- 
sion. This intention <3an commonly be insured in less time, 
and with less risk to the patient, by the external application 
of heat, which, if sufficiently done, will leave the skin per- 
manently excited, and the bowels corrected ; except that if 
there existed a previous organic error in any of the viscera, 
after arresting the alarming appearances which constitute 
cholera morbus, the patient may be treated as his condition 
may indicate. 

In bilious cholic, this practice is pre-eminently important. 
In this affection we commonly have a diseased liver, a con- 
gested state of the viscera, or more frequently a gorged con- 
dition of the venae portas, and an inflammatory state of some 
one of the intestines. Cathartics fail to operate, whilst ex- 
cruciating pain threatens the destruction of the patient. In 
such circumstances blood-letting is indispensable. But in 
consequence of the ill condition of the blood making organs, 
there is danger that the excitement of the surface may fail 
before the blood-letting will have been effectual in correct- 
ing the inflammation. Hence all the reasonings which have 
been offered in support of the necessity of keeping up the cu- 
ticular excitement, in any case, are emphatically applicable 
to this. From much experience, we have learned, that it is 
useless to administer a cathartic, until the inflammatory ac- 
tion is well'subdued. Enemata of a mild sort are never in- 
jurious, and it is in no case amiss to employ appropriate do- 
ses of calomel, in view of correcting the local and general af- 
fection. Therefore, after a decisive blood-letting, we apply 
the external heat, intensely, then administer an ordinary dose 
of calomel, and follow it, after three hours, with a dose of 
castor oil. If it succeed in procuring catharsis, so far well ; 



DIAPHORETICS. 333 



if not, the recurrence of pain and other concomitant appear- 
ances, will soon make known the necessity of blood-letting : 
which done, we coerce reaction by a repetition of heat j and 
so on, until the skin fails to obey heat alone. Then an epis- 
pastic eight by ten, or ten by twelve inches, is necessary to 
keep up the centrifugal action,, until the intestines shall have 
been, relieved. 



334 DIAPHORETICS. 



CHAPTER X. 

DIAPHORETICS, CONTINUED— RULES RESPECTING THEIR 
APPLICATION. 

Diaphoretics are particularly indicated in all those febrile 
affections which are consequent on the influence of atmos- 
pheric vicissitudes. The first link in the chain of morbid 
action, in diseases from this cause, is torpor of the cuticular 
surface ; of course of the perspirator}^ vessels. It is always 
therefore greatly important, to secure a full establishment of 
the excitement of the skin. 

In the phlegmasia?, diaphoretics are among our most com- 
mon and useful remediate means. Taking care not to use 
stimulating diaphoretics when the febrile excitement runs 
high, until the inordinate action of the heart and arteries 
shall have been previously moderated by bleeding, and suit- 
able evacuations of the bowels. Such articles, however, as 
are known to be refrigerent, or relaxing diaphoretics may be 
used in fevers of the most inflammatory character. 

In the treatment of intermittent and remittent fevers, dia- 
phoretics are among our most common and useful remedies. 
When there is a hot and dry skin in fever, it is invariably at- 
tended with increased distress to the patient ; and nothing 
affords so much relief as a free perspiration. It is not always 
necessary, however, to procure a copious sweating ; common- 
ly it is quite sufficient to keep the skin moist, being careful 
to evacuate the bowels, before we have rocourse to diapho- 
retics. This is necessary, because any considerable irrita- 
tion of the bowels would prevent diaphoresis : and if there 



DIAPHORETICS. 335 



be any undue fullness of the viscera, it will be found that an 
attempt to excite a diaphoresis will serve only to increase the 
distress. If the action of the heart and arteries be very con- 
siderable after blood-letting, we should use nitre, antimony, 
4*c. In fevers of a low, vascular action, with a burning and 
dry skin, stimulating diaphoretics must be used in conjunc- 
tion with suitable applications to the external surface, such 
as cool or tepid affusions. In typhoid fevers, it is of very 
great importance to excite the skin and the subcutaneous 
vessels. The patient is ordinarily too much prostrated to 
bear the loss of blood. It is therefore important to invite the 
circulation from the organ which is in a state of congestion, 
and do all in our power to maintain the excitement of the 
skin, so as to prevent any avoidable introversion of the blood, 
until the congestion shall have been corrected. This is done 
by the application of cloths wrung out of hot water; blad- 
ders or bottles filled with hot water ; by large sinapisms, or 
rubefacient frictions of the most active kind. These should 
be diligently continued, until the skin shall have sufficiently 
recovered its action to maintain a disposition to diaphoresis. 
Copious sweating is seldom proper in a case of this sort, ex- 
cept at its commencement ; in any event, only in its early 
stages, before the system has become greatly debilitated. 
This form of fever ought to be arrested in its forming state 
as stated above. 

When we intend to excite diaphoresis by ordinary means, 
the patient should be confined to his bed. If the pulse be 
strong, full, and tense, blood-letting should be premised. 
This is a rule so plain that it needs only to be stated. If 
there be a disposition to inflammatory action, the indications 
of which are unequivocal, the same precaution is necessary ; 
if the appearances are doubtful, and it should turn out on the 
administration or application of the diaphoretic agent, that 
the patient becomes more restless, with increasing signs of 
pyrexia, we may then be assured, that more depletion is re- 



336 DIAPHORETICS. 



quired. The state of the general system will direct us in 
the selection of the plan or article to be used in any particu- 
lar case. The profession will tell us unanimously, that 
when the pulse is vehement, antimonials, neutral salts, ac- 
cidulated drinks, cool ablutions, <fcc. are to be employed. 
When there is no appearance of inflammatory action, re- 
course may be had to stimulating diaphoretics. When the 
perspiration appears, it may be supported by appropriate stim- 
ulating drinks. 

Diaphoretics are more effectual after digestion is com- 
pleted : during the performance of this function, the emunc- 
tories of the skin are less disposed to act. Whilst the sweat 
is flowing, bleeding and purging are commonly inadmissible. 
Temperature is to be.regarded, and sudden changes are to be 
avoided. 

The best and most powerful diaphoretic agent, in view of 
the principles by which we should be directed, is dry heat, 
applied to the surface in any manner so as to be completely 
efficient. In explaining the theory which we have adopted 
as a guide to our therapeutics, we have endeavored to de- 
monstrate that in any case in which there is a deficiency of 
excitement, whether through direct or indirect debility, there 
must be a corresponding deficiency of heat. In all cases in 
which the excitement of the skin is in such a state as to re- 
quire artificial interference, there must exist either the stric- 
ture, which is well enough described by Cullen, when he 
named it a spasm, or else that kind of collapse which is con- 
sequent on a too long continued absence of the blood. The 
stimulating and expanding power of heat will be the most 
speedy and agreeable corrective. It is a pleasant circum- 
stance, that when this kind of treatment is particularly ne- 
cessary, it is more or less pleasant to the patient. It is true, 
much will depend on the manner of making the application, 
as well as on the circumstances of the case. In any instance 
of indirect debility, we could scarcely conceive hew exter- 



DIAPHORETICS. 337 



rial heat could fail to be exceedingly comfortable, not only 
because the surface is really cold, but because the strong ten- 
dency of the circulation to determine on the viscera, makes 
it particularly acceptable to the patient, to have both of these 
morbid circumstances simultaneously corrected. In cases of 
direct debility, it is an agreeable application, if the heat is 
sufficiently moderate with a gradual increase of temperature. 
In such cases, we have found that jugs filled with water at 
nearly a boiling temperature, and placed at the feet, knees, 
or sides of the patient, impart the necessary heat in the most 
agreeable manner. Sometimes it is useful to add a little 
good vinegar, by moistening the cloths with it before wrap- 
ping them around the jugs, and after the external arrange- 
ments are all made, and are beginning to take effect, then a 
suitable cordial diaphoretic, may be administered, by the aid 
of which, the diaphoresis will be more complete and ex- 
tended. 

In cases of collapsed skin of some standing, and when it is 
most important to re-establish the ctiticular excitement, in 
many instances, the effect will seem to be transient, till it 
shall have been repeated often and long enough for the re- 
covery of the vitality of the capillary structure of the sur- 
face. In a case of this kind, the operator will receive con- 
viction, that the absence of the blood is the true cause of the 
collapse, and the return and establishment of the circulation 
restores the vitality. 

It has been stated that heat stimulates and invites the re- 
turn of the circulation, whilst it has a constant tendency to 
soften and expand the capillaries for the reception of the re- 
turning blood. Ordinarily, diaphoretics must produce the 
effect by compelling the feeble 'system to assume an action 
which shall recover all those numerous blood-vessels which 
may have become torpid for want of the necessary vitality. 
in the performance of which r it must also overcome the resis- 

22. 



33S DIAPHORETICS. 



tance made by the concomitant collapse, of course requiring 
a degree of propelling power not easily to be estimated. 

Excitement, or the motions pertaining to animal life, ne- 
cessarily require the expenditure of the nervous influence, 
vdiich maintains it. In disease produced by an accumula- 
tion of this influence, such as pleurisies, rheumatisms, &c. it 
is a great advantage to be in possession of an agent, by which 
a degree of expenditure adequate to the accumulation, may 
be speedily and safely accomplished. Heat supplies this 
agent. By the action of heat, we can raise such an intense 
degree of superficial excitement, as shall be sufficient to ex- 
pend the accumulation ; and therefore the effect will be 
more perfect if the application shall be made as intense 
as it can be endured by the patient. The skin is pre- 
pared to bear this kind of stress without injury, and the strong 
and permanent excitement which is produced in this way, is 
effectual in preventing a return of fever. 

Powerful medicines, when taken into the stomach, pass 
on beyond the reach of control, and will have an effect cor- 
responding to their strength, which makes it indispensable 
for the safety of the patient, that the judgment of the physi- 
cian should not err. Heat on the contrary, when externally 
applied, is completely within our control, as it may be retired 
in a moment. Its effects may be instantly counteracted by 
the application of cold. Even if the impression have 
been fully made, and the sanguiferous system have been too 
much excited, an appropriate blood-letting will instantly al- 
lay the threatened violence, and the practice will be follow- 
ed by the most salutary and pleasant effect. 

In cases of chronic gout, or rheumatism, in any instance 
of cramp or internal spasm, as cholic, in which the propriety 
of blood-letting may be doubtful, as also in any instance of 
violent pain from a morbid determination of the sensorial in- 
fluence, we may safely employ this overwhelming agent, so 
as to retire the pain, and permanently maintain the superfi- 



DIAPHORETICS. 339 



ciai excitement ; or if, on effecting a general distribution of 
the excitement, which heat under ordinary circumstances 
will not fail to do, it shall turn out, that blood-letting shall 
be found to be requisite, not only the necessity of deple- 
tion will be evinced, but the patient will receive much 
greater benefit by loss of blood. In many instances, pa- 
tients may be made to receive the benefit of blood-letting 
by the aid of these arrangements, when in a similar condi- 
tion, and under other circumstances, that practice would not 
only disappoint, but do great mischief. 

A stricture of the vessels of the cuticular surface, under 
certain unfavorable circumstances, requires the expansive as 
well as the stimulating power of heat for its correction ; and 
very commonly, if it have Ixisted for any considerable length 
of time, although blood-letting may be imperiously necessa- 
ry, still it will be found most beneficial, and the quantity of 
blood necessary to be lost in the case, will be much more ac- 
curately adjusted by the previous application of heat to the 
cuticular surface. In cases where we may have erred in our 
calculation respecting the reaction after blood-letting, our in- 
tentions can be insured by the same means. 

When the stricture shall not have been corrected in due 
time, and the cuticular surface shall have fallen into a state 
of collapse, it often happens, that no internal diaphoretic 
agent known to the materia medica, will be found adequate 
to the demands of the case, &c. for example, diseases in 
which the skin is particularly emaciated, hard and dry, its 
whole plate so flattened and inelastic, that there can be no 
doubt of its vessels having become nearly impervious. In all 
such cases, the resistance made by the skin itself, to the dis- 
tributive tendencies of the most appropriate remedies, will be 
sufficient to prevent a cure. Sometimes frictions, blisters, 
issues, &c. reiterated again and again, do eventually prove 
availing ; but in most instances they do not. If we have re- 



340 DIAPHORETICS. 

course to the agency of heat, to give expansion to the capil- 
laries, so that a portion of blood can again be admitted ; with 
the returning blood, there will be a return of vitality, and. 
eventually of excitement. And this manner of its manage- 
ment, with the alternation of suitable auxiliaries, if judicious- 
ly conducted, may be made effectual for the recovery of ma- 
ny cases, which under other circumstances would be lost. 

To say the least, when ordinary measures shall have fail- 
ed, we shall deem it due to humanity to have recourse to the 
plan here proposed, which under the most unfavorable cir- 
cumstances, will very often be found powerful enough to 
maintain its just pretensions to sound medical philosophy. 



ALCOHOLIC VAPOR BATH. 341 



CHAPTER XL 



THE ALCOHOLIC VAPOR BATH AS A DIAPHORETIC, AND 

AS THE MOST EXTENSIVELY USEFUL OF ALL 

GENERAL AGENTS. 



In giving our statement on the subject of our apparatus 
for generating and applying dry heat, for the prevention of 
disease, and for the relief of the sick, our readers will indulge 
us in the use of some repetition. 

Having tried the experiment hundreds of times without 
meeting one exception, we assert, that in every case of fever, 
and in all cases of direct debility, artificial heat, in an appro- 
priate degree, brings pleasurable sensation to the patient, and 
may be so managed as to produce cordial effects. 

There are some remarkable and important advantages at- 
tending the use of this cordial, which no other can possibly 
claim. In every case, where properly used, it produces a full 
effect, without imposing any improper stress upon the central 
vessels. So that in securing the most pleasant diffusion of 
excitement, it offers no injury to any of the organs essential 
to life ; ordinary cordials, on the contrary, are dependent up- 
on the struggle which they may excite in the heart and cen^ 
tral vessels, for any and every centrifugal effect which they 
may produce. 

Again, at the same time that heat, by its stimulating pow- 
er, invites excitement to the surface, it softens and expands 
the skin, in a way preparatory to receive the returning blood. 
Ordinarily, cordials must accomplish the effect, by compelling 
the feeble system to assume an action sufficient not only to 



342 ALCOHOLIC VAPOR BATH. 

resume all those branches which it had abandoned because 
it was not able to maintain them, but also to overcome all 
the resistance of an almost lifeless collapse of the vessels on 
the surface, possibly one-fourth part of the system. 

It is true, that heretofore insuperable difficulties attended 
the use of this agent in many cases. But by the aid of our 
apparatus, every difficulty is perfectly corrected, and the ap- 
plication of heat can be made with such precision, as fitly to 
meet the most accurate intention. 

We have said, that " in maintaining excitement, sensorial 
power is expended,'' — and, of course, that "extraordinary 
excitement must produce a preternatural consumption of that 
power." In any case of predisposition with accumulated 
power, such as pleurisy, it must be a very important acquisi- 
tion to have a remedy at hand, by which such expenditure 
can be speedily and safely accomplished. Heat is the agent. 
By raising an intense degree of excitement on the surface, 
every necessary effect can be produced with the utmost safe- 
ty. This is sufficiently evinced by our remarks upon the 
influence of heat in a summer's day. 

We have said that pain also has a considerable effect in 
expending sensorial power. By exciting as much heat on 
the surface as can be borne, the pain of heat, together with 
the concomitant increase of excitement in the vessels of the 
skin, will certainly and safely correct most instances of pre- 
disposition to fever. The skin is not easily injured in this 
way, and the strong determination to the surface, which is 
secured by this method, most effectually guards the system 
after the process is ended. 

Other powerful remedies, when once administered, are 
gone beyond the reach of control, and must have their full 
effect, whether judiciously or injudiciously administered. 
But if too much heat shall have been employed, it is perfect- 
ly within our reach to check its influence, by an immediate 
application of cold.. Besides, if it should be found that the 



ALCOHOLIC VAPOR BATH. 343 

blood-vessels are too much excited, blood-letting will safely 
correct this effect. 

Again, in cases of gout, rheumatism, spasm, cholic, &c, 
when there is a morbid determination or location of excite- 
ment, heat affords a safe agent by which to correct the de- 
termination, and maintain a sufficient degree of general action 
on the surface, till the system can recover a balance. 

The bath produces no loss of vital fluid, and therefore any 
moderate degree of debility produced by it, is quickly recov- 
ered. A pleasant expansion is given to the vessels of the 
surface, and by heat they are stimulated into increased ac- 
tion. The circulating blood is invited from the centre to 
the skin. The intestines, therefore, by being partially de- 
prived of excitement, are for a time relaxed. But when the 
bathing is ended, the circulation returns to its natural equili- 
brium, without any subsequent inconvenience. 

In any case of sudden emergence, the bath may be admin- 
istered by supporting the bed clothes with a staff or board 
of suitable length, or with any sort of a temporary frame, 
taking care to use a few sheets of paper, to defend the 
bed from being scorched ; and to adjust the whole affair so 
as to secure a free diffusion of the heat over the body of the 
patient. 

There should be provided in every family where the bath 
is used, a suitable frame* for the purpose. It might be some- 
thing like the following description : Half a circle, or a half 
hoop of good strength, and twenty-two inches in diameter, 
will form the end which is to stride across the body of the 
patient a little below the breast. A half circular board, eigh- 
teen inches in diameter, will make the foot endof,the frame, 
A thin board four feet long should cover the top, and a lath 

* This frame is highly important, and in many cases indispensable. In 
pleurisies and other violent cases, the heat ought to act at once with con- 
siderable violence upon the whole surface. Indeed, the frame ought always 
to be used whenitis intended to produce a general perspiration. 



344 ALCOHOLIC VAPOR BATH. 

» ' 

or two of similar lengthy should secure each of its sides. A 
hole of suitable size should be made in the middle of the 
foot end, for the introduction of the tube. 

The patient should be stripped of all his clothing. The 
frame is to be laid over him in bed, and a sufficient, weight 
of bed clothes should be used so as to confine the heat pro- 
perly. A sheet, and four or more blankets, or other covering 
to that amount, for the winter season ; a blanket less will 
serve for the summer. The bath is applied at the feet, which 
is most proper in all ordinary cases, and the heat has a free 
opportunity to diffuse itself all round the body of the patient, 
which is alwas important. The weight of the bed clothes 
being properly sustained by the frame, he can turn himself 
over at pleasure, which will give him the advantage of warm- 
ing first one side and then the other, as it may be most agree- 
able to his feelings. 

As complaints should always be met at their first appear- 
ance, before the patient is exhausted by disease, in cases of 
very robust patients, it is often safest to take some blood be- 
fore the bath is applied, especially in the winter and spring 
seasons of the year. It sometimes happens, when the pro- 
priety of blood-letting may be doubtful, that the bath produ-. 
ces partial sweating and temporary ease, but presently the 
perspiration suddenly dries up, and the pain increases. This 
circumstance will at once determine the necessity of blood- 
letting, which, in such an instance, will be found more effec- 
tual after the bath, than it would have been if performed pri- 
or to its application. 

In some instances, also, when the bath is administered to 
patients inclined to be feverish, when blood-letting has not 
been premised, when the bowels need a cathartic, and espe- 
cially when too small a cup has been used, an uncomfortable 
restlessness is felt. This circumstance, as well as a head-ache, 
if they continue any length of time after the bath, should be 



ALCOHOLIC VAPOR BATH. 345 

, ■ - _ _ _ 

relieved by some agreeable cathartic dose, and blood-letting 
when necessary. 

In cases where it may be used with great decision, it com- 
monly produces some throbbing of the head. When this ap- 
pearance is considerable, the process may be discontinued, 
and if blood-letting is not necesssary, the trobbing will quick- 
ly subside. In delicate cases, however, it ought not to be 
pushed up to this pitch ; the fire should be lighted and ex- 
tinguished alternately, as it may be found agreeable to the 
patient. 

In cases of feeble, and very old persons, the smaller cups 
ought to be used. And it ought to be repeated once every 
sixth hour, sometimes once every third hour. Meanwhile, 
the patient should be supported by nourishment and cordials. 
In such a case the intention should be to warm the patient 
effectually, but not to produce a sweat. 

Sometimes it may be beneficial to remove the apparatus 
from the feet to the side of the patient, and so on alter- 
nately, as the judgment of the practitioner will quickly dis- 
cover. 

In cases of long standing debility, it sometimes happens, 
that the bath is scarcely put into operation, before the pa- 
tient feels distressing sickness and faintiness. When this 
happens, let the fire be extinguished, and give a glass of wine 
and water, with a very few drops of laudanum, and when 
sufficiently refreshed, rekindle the bath. 

In all cases, so soon as a full and free perspiration shall 
have been established, let the patient use a napkin to wipe 
the skin wherever he feels inclined to do so, and let an at- 
tendant aid him in wiping his back and lower extremities, 
till the operation is ended ; indeed till he is ready to put on 
his clothes. 

In treating rheumatism, gout, diarrhoea, and all other chro- 
nic diseases, after using the bath, considerable friction ought 
io be continued for half an hour, or longer, before the pa- 



346 ALCOHOLIC VAPOR BATH. 

tient leaves the bed. And when he rises for the purpose of 
dressing himself, he should take a seat at a good fire. Dur- 
ing the intervals between the times of bathing, he should be 
treated with the same kind of friction every evening on re- 
tiring to bed, and every morning before putting on his clothes. 
The friction so continued will expedite recovery. 

In almost every enfeebled case, it is necessary, after the 
bath, to use jugs or bottles, filled with boiling water, or hot 
bricks, to aid the weak excitement of the surface, that it may 
retain the advantages gained by the bath : and in some cases 
blisters should be added. 

There is no danger of taking cold. The hot air which is 
used, is as free from moisture as atmospheric air. It will dry 
a damp sheet. Besides, in all the instances in which it has 
been used, we have not known one, by which the patient 
found any ill effects in that way. Indeed, if such a thing 
should happen, another application, and a little care, would 
perfectly correct every inconvenience. 

When the patient is not much reduced, and seems to be 
too long coming into a state of perspiration, we commonly 
add more heat. If two or more cups cannot stand within the 
base of the bath, we place them in any way we can, propping 
them up with bricks, or any other convenient support. The 
heat of two or three cups will be drawn up by the tube. If 
the patient complain too much, we remove one of the cups 
for a few seconds, and replace it so soon as the heat a little 
subsides. By this method our object is more speedily, cer- 
tainly, and safely accomplished. 

Fleshy patients, if treated with the bath, should be heated 
in a gradual manner. If pale and short-breathed, the decis- 
ion proper in ordinary cases might do much mischtef. In- 
deed, in almost any case, where there is a long standing sal- 
lowness of complexion, it is not proper to force a sweat. In 
these cases, it may require many gently repeated trials before 
a natural state of the skin can be recovered. And in most 



ALCOHOLIC VAPOR BATH. 347 



instances of this sort, blistering, friction and cordials, as wine, 
&c. ought to be employed as auxiliaries to the bath. 

With suitable variation in the degree and continuance of 
the treatment, according to circumstances, the bath will be 
useful in all the following forms of disease, viz : 

In colds, catarrhs, croups, asthmas, pleurisies and fever in 
its various shapes, whether intermittent, remittent, continued 
or nervous. In all these, the application should always be 
general and decisive — taking care to begin the treatment on 
the first onset of the complaint. 

In local inflammation, &c. such as sore breast, in female 
cases — swelled testicle, anthrax or carbuncle, sore throat, 
quinsy, ear-ache, tooth-ache, when produced by cold, or in 
cases of abscess or imposthume, the application may be gen- 
eral at night, and topical or directly upon the part affected, at 
any time in the day. Or if the one method prove ineffec- 
tual, let the other be tried also. 

In St. Anthony's fire, nettle rash, scald head and such like 
affections ; in these the application may be made as in cases 
of local inflammation. 

In suppression of urine, and other painful affections of the 
bladder, in cholic, cholera morbus, and in cases of stragula- 
ted hernia, &c. In these the application should be gene- 
ral and local, more or less decisive, and repeated as the exi- 
gency of the case may require. 

In female complaints of a certain description, including 
difficult labors, floodings; also hysteric fits, cramps, and 
other hysteric affections ; here the application might be gen- 
eral, though sometimes it might be as well, to confine it to 
the lower extremities. 

In piles, whether blind or protruded. Let the application 
be very hot, and direct it upon the part affected, to be re- 
peated as often as the symptoms make it necessary. 

In bleeding at the nose, or in hemoptoe or other recent 
case of hemorrhage. The application should be general, 



348 alcoholic vapor bath. 

repeating morning and evening, keeping fhe patient still and 
warm, and making a free use of table salt, say a teaspoon full 
three times a day or oftener. And if necessary, take the fol- 
lowing pill, viz : take acetate of lead, six grains ; opium, 
three grains : make six pills — give one morning and eve- 
ning ; but let the salt also be continued. 

In excessive fatness. Let the application be general at 
night, to be moderately repeated next morning, and to be 
used two or three times in a week. 

In old age, and other feeble cases. Here use the bath in- 
stead of a warming pan. Warm the patient in his bed night 
and morning, in all cold and' damp weather, still directing 
him to remain in bed till nine or ten o'clock, and then let 
him get up to a fire, whether in winter or summer. 

In gout, rheumatism, &c. Sometimes the application 
should be local, sometimes general, as it may be found most 
effectual. 

Lying-in- women may be put to bed at once, in clean sheets 
and dry linen. Only applying the bath immediately, so as 
to produce a gentle perspiration. 

We have often used it with most satisfactory benefit, in 
cases of whitlow, and every kind of superficial inflammation. 
Its success in such instances, depends upon the same process 
in the vessels, which is excited by Dr. Physic's practice 
when it corrects a disposition to gangrene, by the applica- 
tion of a very large blister. 

The following letters will afford all necessary additional 
information for the common use of the bath : 

The Rev. Mr. Reid is a learned and excellent minister of 
the Presbyterian Church, Lynchburg. 

Lynchburg, September 26. 1815. 

Dear Sir: I have had your patent bath in use in my fam- 
ily about two years, have applied it in a variety of cases, and 
have always perceived the happiest effects to follow. In a 
word, I consider it a most efficient agent in arresting in their 



ALCOHOLIC VAPOR BATH. 349 



incipient state, all diseases originating in cold ; and that a 
judicious person, by its aid, may generally manage all com- 
mon cases of sickness in his family, without medical assis- 
tance. Yours, very respectfully, Wm. S. Reid* 
Dr. S. K. Jennings. 

The following letter is from General Preston, then Treas- 
urer of Virginia : 

Richmond, March 26, 1814. 

Dear Sir: I should be wanting in justice to you, not to 
inform you what effect the application, of your newly in- 
vented hot bath had upon me> in a paroxysm of, the rheu- 
matic gout. The attack was in my ankle and heels of both 
feet, and the great toe of the right. During three days, the 
pain increased, and with such violence, that I was in the 
most extreme agony. In the height of this extremity, my 
brother, CoL Francis Preston, came in to see me and pro- 
posed, rather jocosely, that your apparatus, which was just 
then beginning to be spoken of in the city, should be intro- 
duced to try its effect. As every other of the usual applica- 
tions, such as fomentations, rubefacients, camphor, &c. had 
failed,. I consented, though; without any high expectation, or. 
much confidence, but like other -persons in great pain, was 
willing to try almost any thing which is prescribed for relief. 
It was accordingly introduced and applied, and in about forty 
minutes, before one cup of the burning alcohol was con- 
sumed, it produced a complete remission of the pain ; I fell 
into a sound sleep which lasted nearly seven hours ; and 
when I awoke, was so far restored that; I felt an inclination, 
and thought, I had the ability, to ride in a carriage for, exer- 
cise, which: I would have attempted, if the weather had been 
favorable. On every return of the spasms, which after the 
first application of the bath grew weaker, I used it as seemed 
agreeable; and, with one exception, which I now attribute 
to an injudicious application, it never failed to produce relief. 



350 ALCOHOLIC VAPOR BATH. 

Its utility in such complaints, indeed in all inflammatory dis- 
eases, strikes me most forcibly. I have no doubt that my 
cook was rescued from a severe fit of pleurisy, to which she 
is subject, by a timely and judicious application of your al- 
coholic bath. She was completely restored to her usual 
health in two days. With sentiments of high regard, I am, 
dear sir, your obedient servant, J. Preston. 

Dr. S. K. Jennings. 

Col. John Ambler was well known as one of the most re- 
spectable citizens of Richmond. 

Richmond, March 14, 1814. 

Dear Sir : For some weeks past I have made use of your 
steam bath, in cases of cold and fever, where there have 
been evident marks of violent inflammation, attended with 
great pain. In each of these instances the patient has been 
relieved within a few hours. 

I have also used it in a cutaneous complaint of long stand- 
ing ; although the disorder is not removed, still the general 
health of the person has been evidently improved from the 
use of the bath. I am, respectfully, your friend and most 
obedient servant, J. Ambler. 

Dr. S. K. Jennings. * 

Mr. Grigsby, who follows next in order, is a respectable 
citizen of Prince William county, Virginia. 

August 2, 1815. 

Dear Sir: Injustice to you and to the community at 
large, I cannot longer be silent upon the good effects which 
I have witnessed from the use of your patent steam bath. 

In June, 1814, I was taken ill with a dysentery, while in 
the city of Richmond. My friends thought I would do well 
to recover in four weeks. The bath was twice used and I 
was cured without other remedy. I immediately purchased 
one for myself. Shortly after a Miss Cowles of my neigh- 



ALCOHOLIC VAPOR BATH. 351 

borhood, was taken sick at my house. A bilious cholic. So 
extremely ill that she was unable to undress herself. I 
treated her with the bath till a free perspiration was pro- 
duced. It gave her entire ease. She slept well that night, 
ate heartily the next day at every meal, and was quite well. 
She was habitually subject to attacks of the same kind, 
which in every former instance had required much medical 
attention. It has been more than twelve months since she 
was cured by a single application of the bath, and there has 
been no return of her complaint. She now constantly asserts 
that she would rather have the bath, than the best physician 
in the world without it. 

My wife's sister was afterwards taken with a violent bil- 
ious fever. She was cured at once, and says she would not 
take any consideration for the bath if another could not be 
had. 

Mrs. Crisman, a poor woman in my neighborhood, had 
been confined to her house from September until June. I 
gave her three applications of the steam bath, and the next 
day she walked to see one of her neighbors, and has not been 
confined since. 

I visited a friend in Frederick county. In the neighbor- 
hood there was a certain Miss Mitchell, extremely ill with a 
bilious fever. I had carried my bath with me. I went to 
see her, and requested the privilege of trying it in her case. 
She recovered immediately — believes confidently I saved her 
life, and expresses much gratitude. 

Two other ladies were ill with violent cholic, both of 
whom were immediately relieved upon the application of the 
bath. I myself was the first in this neighborhood who took 
the late epidemic. I had a terrible pain in my head, with a 
wonderful disposition to sleep, and my throat was very sore. 
I was taken about four miles from home. At my request, 
Mr. Foote sent for a bath. I had it applied that night, and 



352 ALCOHOLIC VAP^ 



ALCOHOLIC VAPOR BATH. 



the night following. The next day I got home. My friends 
were alarmed and privately advised my wife to send for a 
physician. But I forbade her. At length she- told me that a 
certain gentleman, a man of good information, had given her 
his opinion, that I should certainly die, and thai the credit of 
the patent steam bath would be gone forever, as it would be 
said that it had killed me. I told her that she could contra- 
dict that statement, inasmuch as she knew I always was bet- 
ter after the application. I used it night and morning to my 
feet, and when my throat would be so sore and stiff that I 
could not swallow, I applied it to my neck, so as to sweat 
my head and neck, which was a great advantage to me. I 
recovered in a few days, and took not one particle of medi- 
cine. Afterwards my family was seized with the same com- 
plaint. Ten of them down at once. I bathed them and pro- 
ceeded in other respects, as your pamphlet directs ; and al- 
though many were sick, through mercy they all recovered, 
and I had no physician. 

On the 1st July last, my house servant was seized with a 
flux. He discharged great quantities of blood, for more than 
a week, before I was made acquainted with his condition — 
two bathings effectually cured him. 

I cannot enumerate all_of the many cases which I have 
already relieved with the patent steam bath. I do not believe 
that even you yourself, can sufficiently appreciate the great 
good that may one day result from this invaluable remedy. 
It will bring lasting blessings on the human family, and I 
believe no man can say too much in its praise, only let it 
be fairly tried. 

From your friend, 

A. Grigsby. 
P. S. — Mrs. Crisman was so drawn up and decrepid with 
rheumatism, that she could not straighten herself until after 
I had given her the bath. 



ALCOHOLIC VAPOR BATH. 353 



Mr. Eppes was a respectable citizen of Lynchburg : 

September 26th, 1815. 
Dear Sir— Having used your patent bath in my family for 
more than two years, I feel it my duty to bear testimony of 
its worth. My wife at one time was seized with a violent 
fever, which increased rapidly, so as to excite alarm. Her 
pulse in the space of three or four hours from the commence- 
ment, beat one hundred and ten strokes to the minute ; I gave 
her the bath, which so completely broke her fever in the 
course of the night, that she was almost well the next morn- 
ing ; some slight feversh symptoms only remained, which 
wore off without any further aid. In two instances a niece 
of ours was very ill. The first, a high fever, attended with 
a sore throat and soreness in the stomach, with greaf stupor. 
The other a case of measles. In each a single application of 
the bath afforded entire relief. In the last there remained the 
breaking out of the measles only, without any pain. Seven 
or eight others of my family were sick all nearly at one time. 
The symptoms were, first a chill, then a high fever, sore 
throat, soreness at the stomach, great stupor or sleepiness. 
Two or three applications of the bath, made at intervals 
in each case, with the aid of a gentle cathartic, restored the 
patients on foot in the space of three to five days ; except a 
single instance only, in which the patient's throat was so in- 
flamed as to compel us to prop her up m bed, in order to save 
her from strangling. In this case, immediately after the third 
bath, blood-letting and a blister plaister were added ; after 
which the patient fell asleep, had a good night's rest, and in 
a few days was restored to health. 

Many other cases, such as pleurisy, rheumatism, dysentery, 
tooth-ache, and great colds ; have been entirely relieved bv 
the use of the bath most commonly without any other 
aid. 

23 



354 ALCOHOLIC VAPOR BATH. 

Hoping that all who try the bath may be attended with like 
success, I subscribe myself your humble servant, 

Hamlin Eppes. 
Dr. S. K. Jennings. 



The following five gentlemen, were all citizens of Lynch- 
burg. Mr. Martin and Mr. Carson, preachers of the Metho- 
dist Episcopal Church. 

Lynchburg, January 1, 1815. 
Dear Sir — I should consider myself wanting in gratitude. 
if I did not communicate the happy effects resulting from an 
application of your bath. My little daughter was suddenly 
seized in the night with a fit of the croup, which threatened 
immediate suffocation. I had recourse to the ordinary mode 
of bathing, which afforded but temporary relief. She con- 
tinued with a high fever all the next day, with threatening 
symptoms of relapse. In the evening 1 applied your bath 
with such success, that in a little more than one hour she was 
entirely relieved, both of fever and ail symptoms of spasm. 

S. Schoolfield. 
Dr. S. K. Jennings. 

January 7, 1814. 
Sir — Encouraged by .the successful use 3^011 made of your 
alcoholic bath, in the case of my wife, when ill of the child- 
bed fever, I have since tried it upon a negro boy, who was 
taken with a violent cold, attended with pains, so that he 
could scarcely move his legs. I repeated the bath several 
times. From the first application he began to mend, and he 
recovered in a very few days, so as to be able to walk about. 
Respectfully, I remain yours, 

Christopher Winfree. 
Dr* S. K. Jennings. - 



ALCOHOLIC VAPOR BATH. 355 

January 17, 1814. 
Dear Sir — I feel it my duty to inform you, that my wife 
who had been for many years much indisposed, subject to 
frequent attacks of violent colds, and when at her best, suf- 
fering almost daily attacks of chills and fevers, has tried your 
patent bath with the most happy effects. Upon three appli- 
cations she was restored to health. It may be proper for me 
to state, that she is sixty-three years of age. 
I am yours sincerely, 

Wm. P. Martin. 



January 30, 1814. 
Dear Sir — My little son was extremely ill of a bowel com- 
plaint. Ordinary medicines were tried in vain ; and I had 
nearly despaired of his life. The bath was recommended 
and tried — its effect was so decisive, that by-standers could 
perceive the immediate amendment, and the child recovered, 
having received a single application. I am yours, &c. 

Armistead Truslow. 
Dr. S. K. Jennings. 



September 25th, 1815. 
Dear Sir — I have for a considerable length of time been in 
possession of your patent bath, and have had occasion for the 
frequent use of it ; my family having been much afflicted. 
I must confess to you sir, that I am highly pleased with it, 
and I think it a great improvement in the healing art. I 
have never known it fail to have a good effect in any in- 
stance in which I have applied it. As an instance, I would 
state that my wife for many years was subject to a violent 
head-ache. I thought proper to use the bath by way of ex- 
periment. It produced immediate relief. I have had it ap- 



356 ALCOHOLIC VAPOR BATH. 

plied to myself, and must say that it is the most pleasant re- 
medy that I ever used. Yours, &c. 

Joseph Carson. 
Dr. & K. Jennings. 



r Mr. Green, Mr. Seaman, Mr. Brougfr, and Mr. Shuster, re- 
sided in the borough of Norfolk. We can say nothing in 
confirmation of the respectability of these men which will 
be contradicted. The concurrence of their testimony will be 
deemed absolutely conclusive, by the citizens of that bo- 
rough, and by all who knew their standing in society. 

Norfolk, October 15, 1816. 

Dear Sir — I was persuaded that your patent bath would be 
of great service to me, the first time I saw an account of it. 
For I had always been very subject to take bad colds, and 
in my younger days, could get certain relief by taking a good 
sweat in the common way ; but after advancing in years, it 
had been with great difficulty I could be brought to perspire, 
and sometimes it could not be effected at all. As soon as an 
an opportunity offered therefore, I procured one. 

1 have now been making use of it for myself and family, 
which is fifteen to twenty in number, for nearly three years, 
and my expectations have been far exceeded. 

From time to time, we have applied it in a variety of ca- 
ses, and never once, without some good effect. In ague and 
fever, when the cases have been recent, they have been cured 
by the first application. In three cases of the cramp cholic. 
and one of them uncommonly violent : in each in about thir- 
ty minutes the patient was in a sound sleep, and within a 
few hours entirely well. 

I think it a duty I owe to you, as well as to the public, to 
state two particular instances, which have happened to my- 
self. Sometime last fall I was much disordered in my bow- 



ALCOHOLIC VAPOR BATH. 357 

els, for nearly a week ; occasioned I presume by a bad cold. ' 
It seemed as if it was so ordered by Providence, that the full 
effect of the bath might be tried. I had gone on neglecting 
myself from day to day, until I could scarcely attend to my 
business. I suffered extremely from a constant tenesmus. 
The gripings were very frequent, and the discharges little 
else than blood and slime. In this condition I went to bed, 
took a bath for about thirty minutes, which kept me in a pro- 
fuse sweat all night. The next morning I had as copious 
an evacuation as I could have wished, and I felt entirely 
clear of the complaint, without taking one particle of medi- 
cine. The other instance happened about six weeks since. 
I was suddenly seized with a violent pain in my back and 
hip, so that I could not turn myself in my bed, any more 
than if my back had been broken. I applied the bath, in six 
hours I could sit up, and in a day or two was entirely well. 
Mrs. Green has applied it in a number of cases, to her poor 
neighbors, and scarcely ever without success. She has treat- 
ed such cases as ague and fever, sore throat, rheumatism, dis- 
ordered bowels, and even the tooth-ache. 

In short, I think I can safely say, we have not only been 
saved from much sickness, but also from much expense. In 
the space of three years, we have not called in a doctor more 
than three times. I have only now and then to get a dose 
of physic from the apothecary, and, that with the bath an- 
swers every purpose. I must furthermore add, that I never 
have received the smallest injury, though I have frequently 
got up before sun-rise and gone about my business as usual, 
after sweating profusely all night. 

I am, with great respect, yours, &c. 

Richard L. Green. 

Dr. S. K. Jennings. 

Norfolk, 10th October, 1816. 
Respected Friend — I have used the patent steam bath in 



358 ALCOHOLIC VAPOR BATH. 

my family for nearly three years, and am prepared to say, 
that its usefulness has far exceeded my most sanguine expec- 
tations ; I feel it a duty to mention some among the many in- 
stances in which it has been proved. 

Two grown persons attacked with the cramp colic, appa- 
rently in the most excruciating pain, were perfectly relieved 
in a short time, and in both instances were in a sound sleep 
in less than thirty minutes, and no return of the complaint 
since. 

In several cases of the epidemic* that prevailed in the winter 
and spring of 1814 and '15, I also used the bath. It was 
found equally beneficial, and I can add, that its usefulness in 
a private family was made more conspicuous, from the cir- 
cumstance of some of the above instances happening in the 
night, when it was difficult to get a physician, and I have 
never hesitated to make use of it without medical advice. 

I have myself for many years been afflicted with a com- 
plaint in the head and stomach, and could find no relief but 
by blood-letting, and that only temporary. I have latterly 
tried the alcoholic bath, and have every reason to hope that 
I shall be able to lay aside my former painful remedy. 

Thomas Seaman. 

Norfolk, October 12, 1816. 

Dear Sir — If a certificate from me, respecting the efficacy 
and convenience of your patent bath, can be of any use to 
the public, you are welcome to the following facts. 

I have been using your method and apparatus in a family 
way, upwards of two years and a half. My family is large. 
I make no pretension to medical skill, and Mrs. 6rough more 
frequently applies it than any one else. Still however, af- 
ter repeated trials, I am prepared to say, that our success has 
been fully equal to any thing which you had promised ns in 

* Pneumonia Typhoides. 



ALCOHOLIC VAPOR BATH. 359 

the pamphlet upon the subject. In a number of instances, 
we have waited upon our friends and neighbors, and with 
the same uniform success. 

Mrs. Brough has been afflicted with a gouty or rheumatic 
complaint for ten or twelve years past, and was generally 
confined during the whole of the winter. The last winter 
she used the patent bath upon herself, every night for three 
or four months ; and two or three times a week for the re- 
mainder of the time, reckoning from the first of the year. 
She went abroad the most of the winter, and her general 
health is now very much improved. 

We have used it in the commencement of several cases of 
small pox, in the measles in a number of instances ; in agues 
and fevers, colics, and in all sorts of complaints, such as in 
a family way we ascribe to the taking of cold. In all these 
instances we managed the business as well as we could, 
agreeably to the instructions which you have given in the 
pamphlet ; and we never failed of meeting with a degree of 
success even beyond our expectations. 

I candidly think this remedy ought to have a place in eve- 
ry family. At least for myself, I would not be deprived of it 
now I know its worth, for ten times, no not for fifty times its 
cost. 

I am, with much respect and esteem, 

Robert Brough. 

Dr. S. K. Jennings. 

Norfolk, October 19, 181&. 

Dear Sir — Having used your bath for nearly three years> 
with great success in my family, 1 feel myself bound to give 
you a detail of some of the good effects we have experienced 
therefrom. 

There is residing with me an old lady, who was troubled 
with severe pains every winter for several years. She was 



360 ALCOHOLIC VAPOR BATH. 

perfectly restored by one application, and there has been no 
return of the complaint, although it has been eighteen months 
since she was cured. 

I have proved the good effects of the bath in several cases 
of colic, both upon myself and family. I have known it 
to procure perfect ease in twenty minutes, in the most severe 
cases. It is common for the patient to fall asleep, whilst un- 
der the operation. 

A gentleman came from the country to my house, who 
had had the ague and fever for several weeks. He stated 
that he tried every thing the physicians had recommended, 
and found no relief. By a few applications of the bath, he 
was perfectly restored to health. 

In all cases of bad colds, it is a most effectual remedy, and 
if it were for this only, I would recommend it to all families, 
as a most valuable family article. 

I am pleased with it the more, because we can manage all 
common cases without the advice or attention of a physician. 
Indeed, I must say, that if it is used as you direct, there will 
not be much need for physicians or medicine. 

Perhaps it might not be amiss for me to add, that the Rev. 
Mr. Waters, of Princess Anne, informed me, that in the way 
of charity he attended a great number of persons last winter, 
sick with the late fatal epidemic, and that in every case where 
the bath was applied, the patient recovered. 
Yours, respectfully, 

Jacob Shuster. 

Dr. S. K. Jennings. 



The following letter from Dr. Worth, of Guilford county. 
North Carolina, addressed to the Rev. Edward Cannon, one 
of the presiding elders of the Virginia conference, adds an- 
other instance of local disease, which deserves a place here : 



ALCOHOLIC VAPOR BATH. 361 

Dear Sir — Being called on to attend a lady, who was sup- 
posed to have been bitten by a poisonous snake j* upon ex- 
amination I found the symptoms which attend the bite of a 
viper, such as an acute pain in the wounded part, which was 
the foot, and a considerable degree of swelling, which ex- 
tended up to a ligature, which had been early applied^ below 
the knee. 

Several means had been used in vain, intended to remove 
the pain and swelling j the latter of which had become so 
great, that my patient was not able to move a joint below 
the knee ; and this had been her situation for the space of 
three or four days. I made an application of Dr. Jennings' 
patent bath, locally. Whilst it was in operation, my patient 
informed me, that the pain was much relieved, and that she 
was able to move her ankle. The application of the bath 
only, a few times repeated, seemed to complete the cure. 

David Worth. 

* This lady was bitten in the night. 



362 EPISPASTICS. 



CHAPTER XII 

EPISPASTICS. 

Epispastics, anciently, included all such articles as produce 
redness, inflammation, or vessication, when applied in contact 
with the cuticular surface. At present, the term is confined 
to such substances, as excite the skin so much as to produce 
vessication. 

The rationale of their operation in the cure of disease, has 
been, perhaps still is. a subject of controversy. Formerly 
their value was ascribed to the evacuation which they pro- 
duced. At present some judicious physicians are of opinion, 
that their secondary or purulent discharge, is more advanta- 
geous than the first effusion of serum ; and think themselves 
confirmed, by the security which ordinarily awaits their pa- 
tients, when abscesses occur : by the good effect which is 
often produced by the establishment of eruptions on the sur- 
face by the antimonial plaster, or other similar means. They 
are furthermore confirmed, by the reverse effect of drying up 
the eruptions, which are common behind the ears of infants, 
and for the correction of which, the re-establishment of the 
excoriation is generally effectual. Besides, the good effects 
of blisters are seldom conspicuous, until the secretion of pus 
commences. It is the fact, however, that a vessicated sur- 
face is beneficial, rather by its secondary effect in maintaining 
a determination to the surface, than by any direct influence 
which it can have, merely as producing so inconsiderable an 
evacuation. 

Dr. Eberle says, u when we advert to the nature of the 



EPISPASTICS. 363 



diseases in which blisters act most beneficial, it appears ev- 
ident, that their salutary operation must depend, mainly, on 
diverting the circulation from the affected organs, and direct- 
ing it upon the vessicated part. Thus, blisters applied to the 
side in peripneumonies, establish an increased determination 
to the surface, and by this effect produce a derivation from 
the inflamed vessels of the pleura and lungs, enabling them 
to recover their healthful state." A blistered surface, he 
thinks, may be considered in the light of an excretory organ? 
the formation of which requires the establishment of a new 
current of determination of the blood. So long as the dis- 
charge continues, there will be an especial demand for blood 
in the blistered part, and a consequent derivation of the cir- 
culation from the inflamed and engorged vessels of the 
neighboring organs." The Doctor's opinion appears to be, 
that the local determination of the blood procured by the 
blister, and not an improved condition of the entire skin, is 
to be considered as the mediate effect, by which epispastics 
do good. The benefit sometimes derived from the applica- 
tion of a blister in erysipelas, he ascribes to the relief afforded 
to the inflamed cutaneous capillaries, by effecting their evac- 
uation by the discharge of serum. 

The beneficial effect of blisters has been ascribed to their 
stimulating and cordial effects. Dr. Chapman says " that 
these remedies are cordial and exhilarating," and considers 
this position to be established, by their efficiency in all ner- 
vous affections, whether distinguished by mental or corporeal 
infirmity and weakness." It is a fact, however, that in cases 
of great debility, blisters are most beneficial as mere rubefa- 
cients ; and that if they produce a great discharge of serum, 
they serve to increase debikty. * 

Dr. Cullen was inclined to ascribe the utility of blisters, to 
their supposed power of relieving spasm. Dr. Eberle thinks 
that the correction of internal irritation and congestion, and 
the relief of the internal organs from pain, may give a healthy 



364 EFISPASTICS. 



impulse to the various emuctories of the system, enabling 
the cutaneous capillaries to resume their proper action ; and 
that in this way, and not by a relaxation of the system, it is, 
that the skin becomes moist under the influence of blisters. 

In presenting our views on the subject of diaphoretics, we 
submitted the principles which explain the modus operandi 
of epispastics. In the degree in which they induce pain and 
excite irritation, they may be employed as counter-irritants. 
With this intention they are used in any instance of painful 
disease, and are applied as nearly as practicable, over the 
pained part. The serous fluid which is discharged from the 
vessicated surface, may in some slight degree imitate deple- 
tion, but the increased excitement of the capillaries will more 
than compensate the loss of fluid. Blisters, therefore, will 
not induce debility. If the blistered surface present a puru- 
lent discharge, the improved condition of the patient which 
almost invariably accompanies that appearance, is not ascri- 
bable to the discharge, which never is purulent till the skin 
is in the condition which promises convalescence. We have 
seen an epispastic applied and thrice repeated on the same 
portion of surface, before the skin could be roused sufficiently 
to effect a purulent discharge. 

When the capillaries languish in defiance of warmth, fric- 
tion, liniments or sinapisms, then blisters become indispensa- 
ble ; and the blistering point arrives whenever the capillary 
action threatens failure, which may happen before an attack 
of fever is apprehended by the patient. In a case of conges- 
tive fever, a pallid condition of the surface, associated with 
an alarming congestion of the portal circle, are the first dis- 
cernible symptoms of the morbid condition which threatens 
destruction. We have se^i a snfall work published by Dr. 
Daniel, of Savannah, who succeeds in very alarming cases of 
this sort, by making an extensive application of sinapisms 
over the chest, abdomen, and a portion of the extremities. 
This is his first remedy, which he continues until very sore 



EPISPASTICS. 365 



excoriations are produced, and which are followed by consid- 
erable ulcerations. By this practice, the capillary action of 
the skin and a resuscitation of its functions are established, 
which is the most important effect of epispastics. The pro- 
fession has been led astray, as to the time and manner of ap- 
plying epispastics and sinapisms, in treating fever — whether 
bilious, congestive, or other forms of fever. Many are of 
opinion, that such applications in the early stages of disease, 
act as additional stimulants and increase the morbid action. 
We know from experience, that in cases which require little 
more than decisive blood-letting, the application of a large 
blister immediately after the first or second blood-letting, 
will make another bleeding necessary sooner than it would 
have been required, if the blister had been longer delayed : 
and that by it, much time is saved and distress prevented.* 
In some instances of pneumonic affections, it may be more 
convenient to the patient to deplete the vascular system well, 
before recourse be had to the use of epispastics. v But the state 
of things is different in bilious fevers, and especially such as 
are congestive. These are accompanied by great fullness of 
blood in the abdominal viscera, requiring excitation simulta- 
neously with evacuation. Great fullness of the vascular 
structures of the abdominal viscera, requires excitation of the 
absorbent system, that the blood which is delayed in the por- 
tal and other veins of the intestines may be hastened for- 
ward, to be subjected to the agency of the function of the liver, 
or be impelled into the vena cava, and entering into the cir- 
culation, admit of a diminution of its volume, by blood-let- 
ting, and of rectification by the continued agency of the 
blood-making organs and functions. Cases of this sort re- 

i* It will be perceived by the reader, that reference is here had to sueh 
cases as require frequent repetitions of blood-letting. In instances of that 
sort, the ability of the system to react has to be regarded. This point being 
secured, commonly the shorter the interval between the times of blood-let- 
ting the better. 



366 EPISPASTICS. 



quire special attention to the condition of the skin and of the 
superficial veins. Sometimes a hot bath should be the first 
remedy; sometimes friction, with or without some heating 
liniment. In almost every case, after the bath or friction, 
sinapisms or epispastics, perhaps both should be applied ex- 
tensively and continued until the action of the absorbents is 
waked up, so as effectually to reach the abdominal viscera. 

In whatever manner different physicians may account for 
the operation of blisters, experience has fully demonstrated 
their utility in a great variety of affections. They are im- 
portant in the treatment of all febrile diseases, although all 
great men have not been unanimous in recommending the 
practice. Dr. Fordyce rejected them, not only as useless, 
but as being pernicious. The experience of the profession, 
however, has been more than sufficient, to countervail the 
authority of this eminent individual. 

Epispastics have not commonly been used in intermittents : 
they are sometimes, nevertheless, of great importance. Re- 
gard is to be had to the state of the skin, in this, as well as 
in any other form of fever. Experience has proved, that 
blistering the extremities, and between the shoulders, will 
cause quinine to succeed in many obstinate cases. 

In idiopathic fevers, blisters are very valuable : but they 
must be judiciously timed, and made to act without inter- 
mission till convalescence is established. If there be organic 
disease with pain, blisters are particularly beneficial, to be 
associated with blood-letting, cupping or leeching, and other 
antiphlogistic measures when necessary. 

Dr. Eberle says, that blisters are essentially of service, 
about the time that the symptoms which formerly were con- 
sidered critical • such as increased action of some one or more 
of the functions, or the formation of an abscess ; and that the 
blisters are useful at that stage, by producing an artificial cri- 
sis. They should be used only, however, he thinks, when 
the indications of a critical change are obscure or impractica- 



EPisPASTics. 367 



ble ; that during the time of a critical discharge, they are in- 
admissible. According to our theory, the proper time for 
commencing the use of epispastics in such cases, would anti- 
cipate the Doctor's rule, possibly by an entire week. 

In visceral affections, the object is to relieve the oppressed 
organ, therefore we apply our epispastic, as near as we can, 
to the affected viscus, in order to profit by derivation. In 
delirium we blister the head, or the back part of the neck. 

In all the varieties of phlegmasia?, blisters are important. 
In acute pulmonic affections, they are indispensable. There 
is a difference of opinion as to timing them. Some say they 
are injurious if used before the necessary depletion ; others 
say, they may be used from the commencement. We have 
shown that we may apply blisters, and then bleed while they 
are making their impression. 

Dr. Armstrong intimates the impropriety of early blister- 
ing, as hydrothorax has resulted from the practice. If this 
disease did follow the application of an epispastic, it was not 
caused by the blister. We believe the effusion in such a 
case, to have been the result of insufficient blood-letting — 
counter-irritation had been relied on in cases, in which de- 
pletion ought to have been the principal remedy. In pul- 
monic affections, we commonly blister the chest. Some wri- 
ters, however, recommend their application to the thighs and 
legs. We contend for making the application sufficiently 
extensive, and likewise continuous. Baglivi observes, that 
a difficulty in respiration and expectoration, which sometimes 
occur about the fifth or sixth day, will be relieved by two 
blisters applied to the legs and the thighs. This practice 
was recommended by Hippocrates ; it is also noticed and 
strongly recommended by Van Swieten and others ; to all of 
which we add that, if large enough, it matters not where 
they are applied. 

In hepatitis, chronic and acute, blisters are beneficial, 
when any pain, or the state of the skin call for their use. In 



36S EPISPASTICS. 



enteritis and peritonitis, they are indispensable in almost 
every instance. In acute hydrocephalus we blister the 
scalp. In all these forms of disease, we let blood in the first 
instance. 

In acute rheumatism we blister over the pain : sometimes 
in like manner, when the disease is chronic: so also in scia- 
tica. Dr. Scudamore recommends blisters in the worst 
chronic states of neuralgic rheumatism. They promise less 
in these affections than in most other painful diseases. In 
gout ; they are recommended by some and condemned by 
others. Rush and Musgrave recommend them, as well in 
gout as in rheumatism. Cullen and Scudamore consider 
them hazardous. When the skin shall have been neglected, 
and protracted disease shall have worn down the energies of 
the system, at length the irritation which attends on gout and 
rheumatism, so entirely employ the sensorial influences that 
the skin becomes greatly emaciated, and on careful inspec- 
tion, will be found nearly as thin as parchment. A blister 
applied to such a surface, especially if of the dimensions 
commonly used in the days of Cullen, would produce a dis- 
tressful sore, if not a dangerous sloughing. Not so, however, 
if blistering be judiciously employed from the commence- 
ment, so as to maintain a just balance of excitement. 

In dysentery, we apply them to the abdomen and to the 
extremities. Cantharides are often too slow, and in cases 
requiring haste, we use dilute nitric acid, or Granville's lo- 
tion. In cholera infantum, blisters or Rubefacients are neces- 
sary. This practice is too often postponed till the vitality 
of the skin is gone past recovery. 

In exanthemata — confluent small pox and measles, espe- 
cially when the eruption recedes, blisters are often greatlv 
useful. Measles are said sometimes to fall on the breast or 
bowels — the effect of this disease on the cuticular surface, is 
such as to leave the capillaries in a state of great debilitv. A 
very little exposure to a chilling temperature, so entirely si- 



EPISPASTICS* 361* 



lences the superficial excitement that a very dangerous intro- 
version may suddenly follow such exposure ; the consequence 
is, not a falling of the measles upon the thoracic or abdom- 
inal viscera, but a new inflammatory disease, the effect of 
exposure to cold. After measles have much enfeebled the 
patient, and in some low cases of typhoid fever, blistered sur- 
faces are liable to run rapidly into gangrene, or to become 
sloughing sores. I This is well explained by Dr. Armstrong, 
and it is the effect of debility. 

Blisters are useful in erysipelas, as also is the alcoholic 
bath j and for the same reasons — they improve the condition 
of the skin. 

Blisters arrest gangrene by exciting the action of the cir- 
cumjacent surface. Cotunnius gives an interesting account 
of gangrene,' consequent on putrid fever, in which the gan- 
grene stopped about a finger's breadth below the margin of 
the blisters. Roemer also admits their power in arresting 
gangrene. But we are indebted to Dr. Physick for our 
knowledge of the value of this remedy in gangrene. The 
blister should be large enough to cover all the sound parts in 
the neighborhood of the gangrene, which will be arrested at 
once, by this treatment. 

Blisters are beneficial in some instances of hemorrhage, 
especially in epistaxis. In this affection we blister the back 
of the neck. This was proved by Dr. Robert Archer, of 
Norfolk, Va. The blister arrested the bleeding during its 
continuance — when the blister dried, the bleeding returned. 
The blister was then kept open for some time, and the pa- 
tient was cured. 

In the treatment of spasmodic affections, blisters often dis- 
play very great effects. They are employed in tetanus, but 
to be useful, they must be very large in such affections. Dr. 
William Carter blistered the shoulders and the whole length 
of the spine. He also gave an active purge every second or 
third day, and cured his patient in less than three weeks, 
24 



370 XPISPASTICS. 



Blisters have been much used in epilepsy. They are 
most beneficial, when the patient shows signs of irritation of 
the brain during the intervals ; when the patient is dull and 
sleepy, and his pulse is small and trembling ; some say blis- 
ter the calves of the legs. Riverius and Piso blistered the 
scalp, and kept the blisters running. But there are many 
incurable cases in which blisters will do no good. 

They are also useful in inflammation of the joints. They 
must be kept running a long time, associating rest and the 
necessary evacuations. 

They may be used in treating an inflamed vein, an acci- 
dental disease in which Dr. Physick first introduced the 
practice. We protect the orifice with a plaster of simple ce- 
rate, then cover the whole of the inflamed surface, extending 
three or four inches from the orifice in every direction. 

For painful incontinence of urine, blister the sacrum. 
Black and Richter blistered in herpetic affections. An incor- 
rigible eruption sometimes takes possession of the face. 
Ambrose Pare narrates a case of this sort, so bad that it was 
considered to be elephantiasis. A blister was applied : it 
produced strangury, and the patient was cured. 



PART IY 



PRACTICAL APPLICATION 



OF THE FOREGOING PRINCIPLES. 



PART IV. 



in Anatomical Sketch, which is followed by a selection of Diseases, 

intended to exhibit a pathological and practical application, of 

the elementary principles which have been kept in 

view, in the preceding parts of this work. 



CHAPTER I. 

AN ANATOMICAL SKETCH, WITH PHYSIOLOGICAL RE- 
MARKS. INTRODUCTORY TO THE PRACTICE, &c. 

The vascular system consists of three orders of vessels ; 
arteries, veins, and lymphatics. The heart is the central or- 
gan, in which the large vascular trunks all unite, and from 
which they divide and ramify, as they are extended through- 
out the system. The sum of the calibres of the branches 
taken collectively, is greater than that of the trunks, calculated 
at their commencement. The circulation may therefore be 
said to form a cone, of which the heart is the apex and the 
smaller vessels the base. By this disposition, no important 
resistance to the action of the heart is felt by that organ, 
except when some one or more branches are in a state of 
congestion, or are otherwise diseased. 

The sanguine vascular system consists of three parts. 1. 
Arteries. 2. Capillaries, a system of vessels having proper- 
ties and functions, sui generis, peculiar to those vessels. 3. 



374 ANATOMICAL SKETCH, ETC. 

Veins. Arteries conduct the blood from the heart to the ca- 
pillary structures ; and some are of opinion that by the power 
of the heart and arteries, the blood is propelled into and 
through these structures. Arteries have little if any sensi- 
bility. This opinion has. the authority of Haller, Aysten. 
Bichat, Magendie, &c. Arteries have three coats. The 
external coat is cellular ; the middle, which is the proper 
coat, is fibrous ; the internal is serous. This last is liable to 
irritation. When mercury acts as a poison, it excites an in- 
flammatory condition in this coat, which is found also to af- 
fect the heart. 

Capillaries are the extreme ramifications of blood-vessels, 
in which the arteries terminate : and in which the first radi- 
cles of the veins have their origin. No line of demarcation 
can be drawn between them on structural principles : physi- 
ological and pathological facts demonstrate differences in 
their modes of action, and in their vital forces and functions. 
We therefore infer, there must be also dissimilarity in their 
structure. They are most irritable ; and the irritability of 
any organ or structure, is in proportion to the amout of its 
capillaries. They are supplied with a degree of vitality, 
which enables them to sustain a circulation and perform 
functions peculiarly their own : and except that the heart 
propels the blood through the arterial trunks, and by that 
agency keeps up a supply for the capillaries, they carry on 
the circulation, in a manner independent of the heart. The 
capillaries of the external surface perform various functions. 
They secrete the material which is thrown off by perspira- 
tion ; they develop and discharge carbonic acid gas ; they 
divide the blood and lymph • they radiate heat and counter- 
act cold ; and they transmit the blood from the arteries over 
to the lymphatics and veins. All these actions and functions 
are known by induction only, since they cannot be seen, even 
with the assistance of a microscope. Mons. Dutrochet of 
France, and Dr. Jackson of Philadelphia, are of opinion, that 



37& 

what is regarded as capillary circulation, is not performed by 
close vessels, constructed in tubular form ; since the current 
of circulation obviously flows in every direction. Currents 
commence abruptly at points where in the previous instant, 
none existed. Moreover, by applying a mechanical irritant, 
the whole tissue under observation is made to assume the 
appearance of a mass of moving globules, passing on in every 
direction, with„great diversity in their velocity, and striking 
off laterally into the surrounding structures. Therefore, say 
they, the blood, as circulated through the capillaries, is not 
confined in close vessels. 

Let us imagine a portion of cellular structure, spread out 
like a piece of lace, whose threads are all little tubes, inos- 
culating wherever their winding course brings them into con- 
tact, and anastomosing in every direction ; let a number of 
such pieces of lace be laid one upon another, until the num- 
ber of layers shall be considerable, and wherever the bending 
tubes of the one, shall come into contact with those of an- 
other, let them again inosculate and anastomose. Now let 
those little tubes be considered to be transparent ; would not 
such a congeries of tubes, so united, afford opportunity for 
the blood to exhibit all the appearances above stated, by M. 
Dutrouchet and Dr. Jackson ? 

This capillary or molecular circulation, has a principal 
agency in the organic actions employed in most of the vital 
phenomena ; sanguification ; nutrition ; calorification and 
secretion ; all are dependent on it. The capillary circulation 
is the seat of sanguineous irritation, congestion, hemorrhage, 
effusion into the interstitial structures; whether sanguine, as 
in apopexies ; echymoses ; potechias ; red indurations ; car- 
nification ; hepatization ; or serous and albuminous effusions 
forming dropsies ; tubereles; white indurations, &c. 

The lymphatic system is reticulated. Its vessels anasto- 
mose in infinite diversity of manner. Some terminate in the 
veins in the neighborhood of their origin ; but the most of 



376 ANATOMICAL SKETCH. ETC. 

(hem, in two principal trunks. They are found in all the 
organs except the brain, spinal marrow, the eye. the external 
ear and the placenta. Magendie says, they do not absorb, 
but receive the white particles of blood immediately from the 
arteries. And why not armed with the power of absorption r 
As the capillaries giving origin to the veins, take up the col- 
ored particles of the blood with its serum, &c, so those of 
the lymphatics take up the transparent particles, which con- 
stitute lymph. In their course, there are numerous glands. 

A gland seems to be an interlacing of lymphatics with in- 
osculating veins and nerves. These glands are more fully 
developed and better nourished in infancy and youth : 
therefore children and young people, are more liable to be 
affected with acute and chronic irritation of those structures. 
The glands are endowed with great irritability, hence scro- 
fula and tubercles, especially of the lungs. Tubercles are 
consequent on chronic irritation of the lymphatics. 

The capillary system is every where connected, and con- 
tains within it, the great mass of the fluids. A disturbance 
in one part, is felt to a greater or less extent in other parts, 
and sometimes an irritation in one part, will involve all the 
functions, so as to bring on disturbance throughout the whole. 
Probably this structure maybe the portion of the system, 
which receives the impression and gives the direction and 
extension, to what is called in modern pathology, the irrita- 
tion of continuity. 

The blood may be accumulated excessively in one part 
and be derived from other parts. The capillaries of the in- 
ternal mucous surface antagonize those of the skin, and the 
condition of these two sets may be in reverse states. Inter- 
nal inflammations and congestions, are accompanied with 
torpor, atony or want of action, and with icelike coldness of 
the surface. Inflammation of the meninges of the brain, is 
ittended with cold extremities. 



ANATOMICAL SKETCH, ETC. 377 



Lymphatics are an annexation to the veins. They con- 
duct a transparent fluid, which in its course through them, is 
nearly converted into blood, probably by an action assimilat- 
ed to that of the capillaries. They have their origin in ca- 
pillary radicles, in the intimate structures of the organs, and 
in the surface of the intestines. Monroe and Henderson con- 
sidered them to commence with open or patulous mouths or 
orifices. Fohman, a German anatomist, was confident that 
in fishes they originate in a cul de sac. This is a matter of 
no importance, since it is a settled point, that all the animal 
membranes absorb fluids. 

Cellular tissue is a white, spongy and soft texture. It is 
diffused throughout the whole body, uniting its various or- 
gans, between which it is interposed, surrounding and pene- 
trating into their interior, and of course forming a part of 
their structure. If it could be presented alone, all other parts 
of the system being removed, it would exhibit the entire 
configuration of the body. The structure is lamellar and 
filamentous; is disposed into permanent irregular and varia- 
ble -areoloe, having a free communication with one another. 
In a healthy state it is thought not to possess sensibility. 
This we know to be an error. It is endowed with irritabil- 
ity, and is susceptible of vital contraction. It is the seat of 
anthrax and phlegmon, than which, few morbid affections 
give more pain, however limited in their extent ; and when 
erysipelas phlegmonoides occurs in any case, we have irrita- 
tion and anguish in perfection. 

It is the seat of serous exhalation, and its moisture facili- 
tates the movement of the organs and of such parts as are 
contiguous, and constitutes an essential membrane for each 
organ, enveloping its minutest particles, and determining its 
form and size. It isolates each organ to a certain extent 
from all others, and by this provision, perhaps, each one is 
in some measure defended from diseased action, which may 



378 ANATOMICAL SKETCH, ETC. 

be prevailing in contiguous parts. Its serosity may accumu- 
late, producing (Edema, when the affection is local, or it may 
be general, as in anasarca. It may be penetrated and infil- 
trated with air or gasses, constituting emphysema. An acute 
inflammation of this tissue, may produce lymph or gelatine. 
The tumefaction in that case, does not pit on the application 
of pressure. A tumid condition of this sort, is in a peculiar 
manner elastic, if subjected to pressure by the application ^f 
a finger. 

With this sketch in view, we will take a brief notice of 
the general circulation of the blood. 

The heart is the great central propelling organ, which is 
supplied with four cavities ; two of these receive the blood, 
and two propel it. We will commence at the lungs. The 
blood collected by the capillaries throughout all parts of the 
lungs, flows onwards towards the heart, through the pulmo- 
nary veins, which are continually uniting and becoming lar- 
ger, until they finally form four large vessels. These pour 
their contents into the cavity of the heart, which is called 
the left auricle. As soon as this auricle is filled, it contracts 
and presses the blood into the second cavity, which is called 
the left ventricle. This left ventricle, when it contracts, 
propels the blood into the great artery called the aorta. 

The aorta passes over from the top of the heart to the spine 
forming a large curve, and gives off branches in its course, 
for the support of the arms, neckband head. Then descend- 
ing down on the left side of the spine, behind the bowels, it 
gives off branches for the support of the thoracic and abdom- 
inal vicera; and in descending, near the hips, it divides into 
two great branches j one of which supplies each of the lower 
extremities. 

All these branches go on dividing and ramifying, until 
they become capillary, and are extended to every part of the 
body, internal and external. And by the action of the capil- 



379 

laries, the blood is changed in its colour, from a lively red, to 
that which distinguishes the blood when drawn from the 
veins. 

The blood collected by the capillaries is returned by veins, 
from all parts of the body towards the heart ; and as they 
approach this organ, all those descending from the head and 
upper extremities, become united in one common venous 
trunk ; and all those ascending from the lower extremities 
and the pelvis, are united in another. These two trunks are 
called the venal canal ; which meet at the heart at an angle, 
and are united end to end, where, by a large opening, they 
pour their contents into the upper cavity on the right side of 
the heart. This cavity is the right auricle. When this auri- 
cle is full, it contracts and forces the blood into the lower 
cavity on the right side of the heart, or right ventricle. 
When the right ventricle contracts it propels the blood through 
the pulmonary artery and its branches, into every part of the 
lungs. In the capillaries of the lungs, the blood is subjected 
to the action of that organ and fitted for another round of the 
circulation. This done it returns by the pulmonary veins, 
to the left side of the heart, and proceeds on again ; thus per- 
petuating the circle. 

It will be useful to add in this place, a sketch of the anato- 
my of the portal vessels. 

The blood that is distributed by the branches of the aorta 
to the abdominai viscera, does not return from the capillaries 
into corresponding veins, like that sent to other parts of the 
body. It is collected into an independent set of vessels, hav- 
ing a structure similar to that of the veins, except that they 
have no valves. These vessels unite and form a large trunk, 
which is called the portal vein, which passes into the liver, 
and its branches are distributed like arteries throughout all 
parts of this large organ. From the dark blood of this ves- 
sel, the liver secretes bile. When this function has been 



380 

j:>erformed by the capillaries of the liver, the blood thus freed 
of its bilious material, is conveyed into the vena cava and is 
there mingled with the general mass of the circulating 
fluids. 

The vena porta is very distensible, and can bear much full- 
ness, if it can be timely relieved. If it has no outlet howev- 
er, but that which is provided through the function of the 
liver. If therefore the liver by any means should become 
very inactive, the yielding structure of the vena porta, may 
subject it to a degree of fulness, such as occurs in conges- 
tive fever. And a very inconvenient degree of distension 
occurs in almost all cases of intermittent and remittent bilious 
fever. The morbid fulness of the portal vessels is the cause 
of the soreness and distress felt in the abdomen in instances 
of fevers of this sort. 



FEVERS CONSIDERED. 381 



CHAPTER II. 

FEVERS CONSIDERED. 

Forty years ago, having then been engaged in the practice 
of physic about ten years, an honest nosolgist, we learned 
our first trustworthy lesson on the subject of fever. 

A gentleman living in Campbell county, Ya. had built his 
house on an elevated spot, in the midst of a very healthful 
neighborhood. To save the expense of erecting a kitchen, 
he dug away the earth on the south side of the house, form- 
ing a basement, three sides of which were considrably below 
the surface of the earth. The floor of the basement was laid 
on logs of post oak, with the bark left on them, except that 
their upper sides were hewed, that the boards might be neat- 
ly nailed upon them. On the side of this cellar kitchen, 
which was next to the fire place, three of the log sleepers 
had their largest ends turned to the upper side of the room. 
As these sleepers had no connection with the frame of the 
building, they were let down, each in a trench suited to its 
size.. If therefore the earth were nearly level, when water 
should be permitted to fall into these trenches, it would flow 
towards the large end of the sleepers. The kitchen table, 
upon which the washing of dishes and the like were perform- 
ed, and the tubs of the washerwoman were placed, had its 
station immedtately over the deep ends of these trenches. 
The slop-water therefore was sufficiently copious to keep the 
large ends continually wetted. The house had been stand- 
ing in this condition twelve years, when, in the month of 
February, the ground being covered with snow, a most 



382 FEVERS CONSIDERED. 



alarming fever commenced among the blacks, who labored 
and slept in that part of the kitchen. The cook, a woman 
over thirty years old. had her bed placed within the distance 
of six or eight feet from the shop table. A girl of fifteen 
years, who assisted the cook, spent much of her time, and 
often slept at the fire, near the same corner. The washer- 
woman was engaged more or less of her time every day, also, 
in the same part of the kitchen. 

The cook was the first victim. She complained of head- 
ache and not much additional inconvenience. Their mas- 
ter, as had been his custom when his people complained of 
indisposition, administered a dose of jalap and calomel. The 
medicine seemed to operate kindly, and the patient consider- 
ed herself much relieved. The following night the girl was 
taken violently ill. Having been sent for before day, we 
arrived early in the morning, and found the case truly alarm- 
ing. ' Excessive pain of the head, accompanied with a degree 
of heat of the scalp, and of the whole surface, such as we had 
never before met; excruciating pain of the back; distressing 
sickness of the stomach and vomiting ; with a pulse about 
one hundred and fifty or more per minute. She was bled, 
and then affusions of cold water were applied to her head for 
several hours. Doses of calomel and ipecac, were repeated 
every second hour. In despite of these remedies, the pain 
of the head and back, and the heat of the surface continued 
incorrigible. After an interval of six hours, the blood-letting 
was repeated, the calomel and ipecac, and the affusions of 
cold water continued some hours longer. When, finding no 
improvement whatever in the case, we informed the gentle- 
man that the prospect was hopeless. 

Before leaving for the evening, we were requested to see 
the cook. We found her seated on a bench, holding on her 
knees a plate well filled with bacon and cabbage, with an 
ample supply of bread, of which she appeared to eat with an 
agreeable appetite. Her pulse appeared to indicate a hope- 



FEVERS CONSIDERED. 383 

ful convalesence. There was no febrile heat of surface, and 
very little thirst. We made a favorable report and set out 
for home. The next morning we were aroused before day- 
light, with tidings that the cook-woman was dead ; the girl 
whom we visited the day before was much worse, and the 
washer-woman was also taken very ill. 

On our arrival, having examined the patients, we inform- 
ed the gentleman that the sickness was malignant and must 
have been produced by some ill conditioned material, which 
we probably would detect under the floor of the kitchen, 
On an examination we found the whole of the sleepers, en- 
tirely decomposed, having left a black earthy deposite in the 
trenches, except only the large ends of the three before men- 
tioned, as being near to the fire place. About three feet of 
these were in the condition of rotten wood, so soft, that when 
compressed in the hand, it would escape like dough, through 
the fingers. Its color was white, and its ordor was that of 
rotten wood only. We were standing and looking over the 
men at work, when the offensive material was first opened, 
and were seized abruptly with an exceedingly severe head- 
ache, which continued for half an hour, but gradually retired 
through the course of the day. 

The whole mass of the rotten wood and water in which it 
had been so long steeped, were removed at once, in one large 
wash tub, not exceeding four or five bushels in capacity. 

The cook-woman, who slept nearly over the pernicious 
material, died within forty-eight hours after her attack. The 
girl who assisted her, died on the third day, and the washer- 
woman on the fifth. 

The cause of this fatal malady having been removed, the 
greater part of the family sickened, amounting perhaps to 
twenty cases ; every case was marked with considerable vas- 
cular action ; the degree of violence varying according to the 
occasions they had to visit the kitchen ; the distances of their 
bed-chambers from the source of the poison, and the differ- 



384 FEVER CONSIDERED. S 

ent temperament of each. All required depletion. Some 
were bled once only, others twice, and some five times. All 
recovered without difficulty or delay. 

Every grade of febrile action was exhibited, and the great 
and important truth demonstrated, that fever, in its essential 
characteristics, is a unit, and that its varieties are the effects 
of contingencies, of temperaments, &c. corresponding to the 
general views already submitted. 

It is a source of gatincation to us, that Dr. Mcintosh, the 
distinguished Scottish lecturer on pathology and the practice 
of medicine, in Edinburg, entertains the same opinion on this 
subject. " After having watched the progress and termina- 
tion of fevers in various climates, I have been led to con- 
clude, that the nature and seat of fever are pretty much the 
same in all constitutions, in all climates, and under all cir- 
cumstances. The leading difference being in intensity, and 
the rapidity with which some run through their course ; be- 
ing sometimes connected with inflammation, sometimes not : 
at other times depending on functional disorder of the body, 
and also upon the lost balance of the circulation, 



INTERMITTENT FEVER. 385 



CHAPTER III. 

INTERMITTENT FEVER. 

In the first part of this work we have given our views res- 
pecting the origin and nature of fever, where we had occa- 
sion to describe it in its intermittent form. To this the read- 
er will please refer. It is there stated that debility first dis- 
ables the capillaries of the skin, which become morbidly af- 
fected by the low temperature of cool nights, especially such 
as occur at the full and change of the moon, as also in times 
of cold and wet weather. The cold air serves to produce a 
stricture in the capillaries. When this error shall have ex- 
isted a certain length of time, an exacerbation is the conse- 
quence. The chilly state of the system, thus set up, is ac- 
companied by an introversion of the blood upon the abdomi- 
nal viscera. If this occurrence should be frequently repeat- 
ed, or if the chill should be at any one time greatly protract- 
ed, the portal vessels become impaired by the distention, 
and the blood by the delay of its circulation in the vena ports, 
is deteriorated. 

TREATMENT. 

In treating a case of fever in this form, the management 
and medication must be accommodated to the existing con- 
dition of the patient. During the cold stage, the circulation 
through the lungs is in thraldom, This inconvenience may 
be lessened by administering a teaspoonfull of paregoric in a- 
tumbler of hot lemonade, an hour in anticipation of the pa~~ 
25 



386 INTERMITTENT FEVER. 

roxysm, or at the earliest notice of its approach, then let the 
patient be surrounded with bottles or small jugs filled with 
hot water, and be covered with a sufficiency of bed clothes. 
If he should be robust, and the anodyne seem to affect his 
head, as the chill is commencing, he should be bled from 
the arm, one pound or more. If the chill do not pass off in 
twenty or thirty minutes, repeat another dose of the para- 
goric and hot lemonade. If lemonade cannot be had, sage 
tea may be substituted. If the stomach be very sick, five 
grains of ipecac, may be administered and repeated every 
fifteen or twenty minutes, until it produce vomiting. 

Bleeding in the cold stage, in a majority of instance, will 
cut short the disease. It will not only put a stop to the pa- 
roxysm, but in many instances it will effect a cure ; and par- 
ticularly in those instances in which quinine seems to fail. 

If the patient be languid after bleeding, apply the vapor 
bath, and continue the application until the reaction shall be 
complete. 

Whilst the bath is in operation, and during the continu- 
ance of the hot stage, let the patient be indulged in drinking 
cold water, to the full extent of his inclination, and as often 
as he desires it ; but he must serve himself with a tea-spoon. 

If there be much heat in the head, make an application of 
cloths well wetted with cold water, changing them often 
enough to keep them cold. If he suffer from general heat, 
wet his skin with a sponge filled with cold water and alco- 
hol, laying off a part of his bed clothes. When the sweating 
stage commences, be careful to prevent his being chilled by 
the sweat. Let him have a napkin in hand, and, if neces- 
sary, let an assistant aid him in wiping away the sweat as it 
accumulates on his skin. Let the wiping be performed with 
energy, so as to cause considerable friction. When this ap- 
plication shall have been pretty well accomplished, let the pa- 
tient rise out of bed, be seated at the fire, and his linen be 
changed. The wet sheets or blankets ought all to be re- 



INTERMITTENT FEVER. 387 



moved. Then place him in a dry bed, covered with the usu- 
al amount of bed clothes. Having made all these prepara- 
tions, let him take one or two grains of quinine every second 
hour during the succeeding intermission ; at the same time 
using one of the compound blue pills, every third hour, until 
his bowels shall be suitably affected. 

About six hours in anticipation of the next paroxysm, ap- 
ply the vapor bath in the usual manner. If there be a re- 
turn of the paroxysm, meet it a second time as above direct- 
ed, regarding all the instructions as before, except only that 
the blood-letting may be omitted, if a stricture across the 
breast, or a pain in the head do not recur. After the chills 
shall have retired, and the patient appears to be convalescent, 
four or six doses of the quinine should be continued daily for 
several days, to prevent a relapse. 

As a feeble state of the skin is the condition which sub- 
jects persons to attacks of intermittent fever, the inhabitants 
of thoseWegions where intermittents prevail, should be care- 
ful to keep up good fires every morning and evening through- 
out the sickly season, and all the day long in wet and cold 
weather. Laborers and others, in circumstances requiring 
unavoidable exposure to cold and night air, would do well to 
protect themselves by taking a cup of hot coffee, or some 
other hot beverage, on going out, and should not fail to 
avail themselves of a good fire on coming in, before retiring 
to bed. 



388 CONGESTIVE FEVER. 



CHAPTER IT. 

CONGESTIVE FEVER. 

This is a fever, in the most severe form of which, the pulse 
and the heat of the skin are generally below the natural 
standard. In slighter cases, the extremities are cold, or have 
a tendency to be cold, while the heat of the trunk of the 
body is increased. The most perfect examples ofcougestive 
disease are exhibited in those individuals, who die in the cold 
stage of intermittents and yellow fevers. This form of the 
disease, like all instances of indospathic fevers, advances in- 
sidiously. The patient is threatened with indispoBtion for 
ten days or a fortnight, perhaps three weeks, previously to 
the time of his confinement to his bed. His appetite is gra- 
dually impaired, his bowels irregular : he complains in the 
mean time of alternate chills and flushes of heat ; till at length 
the alarming chill fastens on him. In mild cases, the heat 
of the skin is diminished, the pulse weak and oppressed, 
beating perhaps fifty or sixty to the minute ; great prostra- 
tion of strength ; tongue moist but loaded with lymph : the 
patient dull and sleepy, but can be roused ; his sensibility ev- 
idently diminished; he complains of giddiness, confusion of 
intellect, heaviness, pain, or a sense of weight, at the crown 
of his head or his forehead. 

According to our view of the course of events which oc- 
cur in fever, the head is first affected. There may be com- 
plications. After the fever is fully established, in the early 
exacerbations, the violence of the action may fix conges- 
tions on the lungs, or the universal langcur of the circular 



CONGESTIVE FEVER. 389 



tion may, by the remora, fix venous congestion on the liver 
and portal vessels. 

When a fever of this sort is about to terminate fatally, it is 
marked by a peculiar expression of countenance ; it looks be- 
sotted ; in the manner of the patient there is an appearance 
of carelessness; his speech slow; his eyes look dim, and 
seem partly insensible to light. If he attempt to walk, he 
staggers like a drunken man. In very severe cases, the pa- 
tients are unable to stand on their feet, or even to lift their 
hands to their heads. A sensation like a great load is felt at 
the pit of the stomach. The respiration short, quick, an4 
weak. The patient becomes more and more insensible; 
picks the bed clothes ; lies on his back, constantly sliding 
down towards the foot of the bed ; his breathing becomes 
more difficult ; his complection takes on a leaden hue ; 
sometimes convulsions occur about this time, and some- 
times vomiting; soon involuntary stools follow, and he 

dies. 

) 

TREATMENT. 

In this, and in every form of fever, it would be greatly 
important that the disease should be arrested in its forming 
state. When this shall not have been done, the case must 
be treated according to circumstances. If the patient be in 
the state of chill, make large applications of mustard. Cov- 
er his breast, abdomen, and his upper and lower extremities 
with mustard plaisters, or wrap him in a blanket wet with 
alcohol and spirits of turpentine, then lay bottles or jugs, fil- 
led with hot water around him on both sides. As there 
shall be appearances of reaction, tie up his arm carefully, 
open a vein, then administer large doses of quinine every 
hour. If the blood-letting be in time the reaction will be 
secured, and the patient rescued from death. 



390 CONGESTIVE FEVER. 



After this shall have been accomplished, the case will as- 
sume a simple form, and may be treated subsequently as if it 
were an ordinary intermittent. 

The reader may have noticed the fact, that the vapor bath, 
which is a most potent agent in exciting and giving estab- 
lishment to the action of the capillaries, is not advised for 
correcting the chilly state of fever, either in its intermittent or 
congestive form. It is not recommended because it is too 
powerful a remedy in such cases. When the capillaries are 
inactive, and the vitality of the skin is too much reduced, 
whilst at the same time the viscera are in a state of conges- 
tion, the general circulation of the blood cannot be made to 
reach the blood-vessels of the skin, within the necessary time 
to protect them against the great stimulant power of heat. 
Under such circumstances, the intended remedy would still 
more diminish the vitality of the surface, and instead of be- 
ing beneficial, in most instances would be greatly injurious. 
This is an important fact, which ought to be kept in view 
in every instance, when the alcoholic vapor bath is employ- 
ed in treating disease. And it may be put down as a gene- 
ral rule, that the bath, if appropriate, will be more or less 
agreeable to the patient. So also, if it be oppressive, some 
auxiliary measure is required in order to insure success. 



INFLAMMATORY FEVER. 391 



CHAPTER V. 

INFLAMMATORY FEVER. 

The symptoms common to fever, are present in a case of 
this sort. There will be heat, much greater than what is 
natural. The pulse will be strong, tense, and frequent, and 
ordinarily, there will be pain. It commonly commences with 
some degree of rigor. The patient feels drowsy, but cannot 
sleep. He is languid and weak. His appetite fails. His 
tongue is moist and loaded with fur, but soon becomes dry; 
and he suffers from great thirst. He complains of general 
soreness, headache and pain in the back, which are often 
accompanied by nausea and, vomiting. These appearances 
progress with various modifications ; becoming more and 
more intense ; the patient meantime is more restless, till 
eventually, he is delirious at night. 

The symptoms vary, however, according to the organ prin- 
cipally affected. 

If the brain be the seat of inflammation, there will be a 
difference in the symptoms, when the. membranes including 
the brain are the structures affected, and when the substance 
of the brain itself is the seat of morbid action. If the dis- 
ease be seated in the membranes, there will be delirium at- 
tended with unnatural increase of strength ; insomuch, that 
it will be difficult to keep the patient in bed. His counten- 
ance will be fierce ; his eyes red, with contracted or dilated 
pupils ; he will complain of headache, or there will be some 
sign by which it maybe seen, that he feels pain in his head. 
If the case be permitted to progress without correction,. hi& 



392 INFLAMMATORY FEVER. 

face may become pale ; his pulse irregular; his tongue dry 
and continually in motion ; his tendons may twitch ; perhaps 
he may pick the bedclothes. If he be young, he may have 
convulsions. He seems sleepy, but his sleep is comatose : 
his pulse, which was weak, becomes slower; then varies; is 
irregular and intermits. His sleep becomes more profound, 
and he dies. 

If the substance of the brain be inflamed, the heat of the 
skin will not be increased. The pulse will be lower than 
natural : it may not exceed sixty or fifty in a minute, and 
even slower than fifty. The extremities may be in motion 
or not : they may be rigidly contracted, particularly the fore- 
arms : or they will become contracted the moment the arm 
is touched, even if it be to feel his pulse. The pupils of the 
eyes are dilated, and the eyelids half or feebly open ; some- 
times one is shut and the other open ■ the tongue is moist till 
towards the last stage of the disease. 

In both varieties, the breathing is very nearly in the same 
state. The bowels generally are confined ; and when it is 
otherwise, the stools are involuntary; which, as well as his 
urine, are passed in bed. Sometimes, however, the bladder 
is insensible and becomes greatly distended. 

if the lungs be affected with inflammation, breathing be- 
comes laborious; sometimes there will be cough with more 
or less expectoration ; sometimes a feeling like rawness under 
the breast-bone and in the wind-pipe incommodes the pa- 
tient ; sometimes a stitch in the side is felt, especially on ta- 
king in a very full breath. 

If there be inflammation in any of the viscera of the abdo- 
men, or of the lining of that cavity, there will be pain in 
that region, which will be increased on making pressure with 
thehaud: it must be remembered, however, that when the 
mucus membrane is the seat of the inflammation, often, little 
or no pain is felt, even on pressure. The patient inclines to 
lie in a position, so as to relax the muscles of the abdomen : 



INFLAMMATORY FEVER. v 393 

there will be more or less tympanites, With considerable heat 
in that part of the body; there will be nausea and vomiting ; 
insatiate thirst ; the tongue is often furred, with an elevation 
of the papillae ; or it is covered with small ulcers or numerous 
fissures ; or it may be red and glazed ; or it may appear as if 
skinned, with or without patches of white fur ; when any of 
these appearances occur, we safely conclude, that the lining 
membrane of the alimentary canal is in a diseased condition. 

TREATMENT. 

In this form of fever, and indeed in all others, it is vastly 
important to have recourse to proper treatment as early as 
possible. The congestions which set up or accompany the 
irritation, are continually growing worse, extending and in- 
volving greater surfaces or larger portions of structure, every 
moment. 

If taken in time, decisive blood-letting once or twice re- 
peated, aided by the equalizing power of the vapor bath, will 
generally put an end to the disease. All medicines calcula- 
ted to irritate the stomach or bowels are pernicious. The 
effervescing draught, or a solution of the citrate of potash, if 
acceptable to the patient, will commonly be useful. Two 
drachms of this article may be dissolved in six ounces of 
water, a little sweetened with sugar ; and half a table spoon- 
full, or twice that quantity, may be taken every two hours. 
Cloths wetted with cold or hot water, may be used as there 
may be occasion ; — cold cloths to the head, hot cloths to the 
chest or abdomen or both. The hands and feet may be fre- 
quently bathed in hot water : and if the patient be not much 
relieved by a second bleeding, apply a large blister, eight by 
ten, or ten by twelve inches square, over the region of the 
stomach, which ought to be renewed as soon as a tendency 
to heal is exhibited, thus making it continuous, till the patient 
shall be recovered. If the case seem to linger, let a moderate 



394 INFLAMMATORY FEVER. 

use of the bath be repeated, every morning and evening, 
comforting the patient with some suitable beverage, accord- 
ing to the instructions given respecting the use of that agent. 

If symptoms indicative of a protracted irritation of the 
membranes of the head, or of the brain continue in defiance 
of the general treatment above recommended, let his head be 
shaved and a large blister applied over the whole scalp, and 
if necessary, repeat it, till those symptoms disappear. 

The diet should be light and fluid. Barley water ; rice 
gruel; two milks whey; afterwards, chicken water; thin 
broth with rice and such like preparations ; gradually in- 
creasing the quality and quantity of his nourishment, in a 
manner corresponding to his progress in convalescence. Du- 
ring the whole dourse of the management, his bowels may 
be kept in comfortable condition, by repeating two or more 
mild injections, every twenty-four hours. The injections 
may be made of very thin broth a little salted, or of thin 
gruel seasoned in like manner, adding a table spoonful- of 
lard or sweet oih 



CATARRH. 305 



CHAPTER VI. 



CATARRH. 



When a patient is seized with chilliness, followed by sneez- 
ing, slight fever, impaired appetite, hoarseness, occasional 
loss of voice, and a cough ; he is said to have catarrh, or a 
common cold. His bowels are out of order, and he has an 
exacerbation of fever and difficulty of breathing at night. 
The cough is sometimes slight ; at others severe. A slight 
degree of wheezing is heard, and the disease has a salutary 
termination in a day or two, by expectoration of mucus, 
which is discharged by occasional fits of coughing. 

Sometimes the disease is confined to the mucous mem- 
brane of the nose, and frontal sinuses, and is then known by 
the common name of "cold in the head." 

When catarrh is a general complaint, attended by conside- 
rable prostration and constitutional symptoms, the disease 
has been denominated Influenza. In this modification of 
catarrh, there is a greater fullness of blood, and a greater 
thraldom of the circulation, in respect of the capillary ves- 
sels of the lungs. 

Catarrh is a slight, sub-acute, inflammation of the mucous 
membrane of the nose, frontal sinuses, the larynx and trachea. 
If the membrane which lines the bronchial tubes be affected 
with a similar inflammation, it may be called bronchitis, 
an affection which has often passed by the name of ca- 
tarrh. 



306 CATARRH. 



Causes. — Exposure to cold, particularly alternations from 
heat to cold, with insufficient clothing. 

It would appear to be of no consequence how cold the air 
we breathe, provided the surface of the body be properly 
protected. It occurs most frequently, and prevails most ex- 
pensively in autumn. A great proportion of the people about 
that season of the year, indulge in hearty eating. They do 
not feel themselves compelled by the weather to put on win- 
ter clothing ; the temperature of the atmosphere, although 
not painfully cold, so as to compel them to use fires, is, nev- 
ertheless sufficiently sedative to diminish the action of the 
superficial capillaries ; in course to suspend perspiration and 
the other functions of the skin. The vitality of the mucous 
surfaces is elevated to the degree preparatory for . producing 
irritation. The reaction which follows is accompanied with 
the symptoms of catarrh ; and the case will be more or less 
severe, according to the existing irritability.* 



TREATMENT. 

In slight cases, one or two applications of the alcoholic 
vapor bath, followed by a moderate cathartic, will be found 
all sufficient for the cure. In cases more severe, especially 
if there be pain in the head, or a sense of soreness or tight- 
ness of the chest, the patient should be bled decisively. 
After blood-letting, he should be treated with an applica- 
tion of the bath, which should be followed by a purge of 
calomel, say five or ten grains, and twenty grains of jalap, or 
instead of the jalap, after an interval of three hours from the 



* To prevent catarrhal affections, begin early in the autumn to have a 
brisk fire, morning- and evening ; and in wet weather delicate persons and 
invalids should keep up their fires throughout the day. 



CATARRHv 397 



time of taking the calomel, he might take two tablespoons- 
full of castor oil. The succeeding day, if the symptoms con- 
tinue to be distressing, let the bath be repeated. If the sweat 
afford pleasant relief, nothing more may be necessary. If, 
whilst under the influence of the bath, the head ache, or the 
tightness across the chest should return, or be increased, im- 
mediately after the use of the bath, have a second recourse 
to the lancet, and give another gentle cathartic, and in a 
large majority of cases this treatment will be all that will be 
necessary. The practice may be similar, whether the case 
be simply a catarrh, or be in some degree complicated with 
sympsoms of bronchitis. 

When delicate persons, particularly those of the fair sex, 
subject themselves to such exposure as is commonly follow- 
ed by catarrh, they should never postpone the necessary 
means of correction. Thousands by such neglect of them- 
selves, have permitted irritations to be established, which 
have ended in that fatal disease, consumption. 



398 BRONCHITIS. 



CHAPTER VII. 

BRONCHITIS. 

There are two modifications of this disease ; acute and 
chronic. The acute form of bronchitis "commences with 
some degree of chilliness, succeeded by signs of fever, hoarse- 
ness, difficulty of breathing, with a dry cough, tightness, or 
a sense of stricture in the chest, and oppression in the region 
between the heart and stomach ; prostration of strength, the 
tongue coated with lymph, and the bowels costive. An ex- 
acerbation is almost always observed at night. In a day or 
two, expectoration takes place, which relieves the patient 
for the time ; the respiration becomes more difficult, but the 
cough bears no proportion to the difficulty of breathing ; the 
tightness about the chest is increased with a sense of suffo- 
cation, and the pulse becomes very frequent. The deadly 
paleness or lividness of the lips and cheeks, becomes more 
and more anxious ; and the patient frequently requests to be 
raised and to have more air. A loud wheezing may now be 
heard, even at a great distance from the bed side. The vo- 
luntary muscles of respiration are brought into play. The 
patient becomes insensible ; a rattling is heard in the throat, 
the extremities and face becomes cold and livid, a cold per- 
spiration bedews the skin, and death soon closes the scene. 

Sometimes the head is seriously affected. When this is 
the case, there will be much complaint of head-ache. It is 
an insidious disease, and in the cases the most dangerous, 
although the oppression in the chest is more or less conside- 
rable, there is neither heat of the skin, pain, nor much febrile 



BRONCHITIS. 



movement in the pulse. There is such an apparent absence 
of fever, that too often no alarm is taken, till the patient is; 
threatened with suffocation, or some organic mischief is done ; 
and then it is too late. 

The disease is very fatal in infancy and childhood. It 
commences in such subjects in the same manner as in adults; 
like a common cold. The breathing becomes oppressed: is 
performed with great effort, the shoulders are in constant 
motion, as well as the nostrils, and the abdomen becomes 
more prominent, by the increased action of the diaphram dur- 
ing inspiration. A sore throat frequently accompanies the 
disease, and the child suffers so much pain during the act of 
coughing, that an attempt is made to suppress it : a wheez- 
ing soon takes place, which is more decided than the difficul- 
ty of breathing ; expectoration is generally followed by mit- 
igation of suffering, which continues for a longer or shorter 
time, till more phlegm is formed. 

The mucous secreted in the air passages, is frequently 
discharged by spontaneous vomiting, exactly as it occurs in 
whooping cough. Children under four or five years of age. 
cannot be made to spit up the pi egm : they swallow it, af- 
ter it has been discharged from the air passages. Children 
refuse food, but drink greedily, until the disease is far ad- 
vanced, when they cannot take a long draught for want of 
breath. 

An infant at the breast sucks pretty well during the 
first stage of this affection ; but subsequently, although 
it seizes the nipple with avidity, it cannot suck for any length 
of time, perhaps for not more than ten or fifteen seconds, 
when it will be observed to bite the nipple very forcibly, and 
discontinue sucking ; it will cry, throw its head back quick- 
ly, and continue in this position for some time, even after the 
cough has produced the expulsion of the mucus. If the dis- 
ease remain unsubdued, the difficulty of breathing increases: 
the face has a livid appearance, the skin becomes cold, the 



400 BRONCHITIS. 



extremities sometimes swell, and the child dies from suffo- 
cation. In all affections of the lungs, particularly in the acute, 
the bowels become constipated, and the evacuations foetid. 

The expectoration in bronchitis, is at first scanty and vis- 
cid, particularly so in the most acute cases ; by degrees it 
becomes more copious and less viscid, and therefore more 
easily expectorated ; till at last it is discharged in considera- 
ble quantities, having the appearance of starch mixed with 
small bubbles of air, and occasionally streaked with a little 
blood, or is discharged in the form of pellets or small lumps. 
If the case go on well, the expectoration gradually diminishes 
and becomes slightly yellow in color ; the patient is troubled 
with the cough and expectoration, in the morning only; at 
length they cease entirely. Sometimes, however, the acute 
disease runs into the chronic form. 

TREATEENT OF ACUTE BRONCHITIS. 

" This depends exactly upon the period of the disease, the 
extent of the morbid action, the state of the cough, the ex- 
pectoration and the previous health of the patient. Bleeding 
is certainly not necessary in every case of bronchitis which 
comes before us ; particularly in one that is slight and con- 
fined to a small part of the lungs ; but if the whole lung be 
affected, and more especially when both organs are implica- 
ted, bleeding is to be had recourse to, early and decidedly." 
If the case be slight, very often one decisive application of 
the alcoholic vapor bath will effect a cure, or at the least so 
change its character, as to remove the bronchitic symptoms, 
and place the system in the condition of simple catarrh ; or 
if the case be more severe, and there shall exist any doubt 
respecting the necessity of blood-letting, the use of the bath 
will make the case plain and easy. 

Dr. Mcintosh says " bleeding is a very doubtful remedy, 
when the second stage is far advanced : and highly injurious 



BRONCHITIS. 401 



in the last." This is true according to the experience of the 
profession ; and the cause of the uncertainty and danger, is 
at hand. As the function of the lung becomes impaired, the 
capillaries of the external surface become more feeble/ and 
their functional action is lessened, so that there is a very 
early tendency to dissolution. 

'If under such circumstances, the vitality of the capillaries 
should be still farther reduced by blood-letting, they may fail 
to react and the patient will be lost. If, however, in such 
doubtful condition, the alcoholic vapor bath be used, the ca- 
pillaries are reanimated, the arterial action greatly improved, 
and any existing necessity for the use of the lancet will be 
readily detected. And for producing this powerful and ben- 
eficial effect, the bath is of the utmost importance. The 
Doctor says, " I know of no disease more under manage- 
ment by any remedy than bronchitis is, by bleeding, if per- 
formed in the first stage, or during the first part of the se- 
cond." The use of the bath places the capillaries in the con- 
dition, which insures the happy effect of blood-letting. 
"Many assert that bronchial inflammation will run through 
a certain course in spite of every remedy; and it will, if the 
inflammatory stage should be nearly over, before discovered, 
or if bleeding be not used in a decided manner," or if the vapor 
bath be not used in its proper place. "Although late bleed- 
ings are to be especially condemned in this disease, yet cases 
do occur, where the lungs become suddenly congested with 
blood, in which a well-timed venesection is of signal service." 

" In the first stage of bronchitis, when both lungs are ex- 
tensively affected, one bleeding will in general suffice." And 
the more certainly, if it be preceded or followed by the use 
of the bath. "And we need not be afraid to carry it nearly 
to fainting, as long as the air passages are freed from mucous : 
but after it has collected in considerable quantities, (and I 
mean my remarks to refer more particularly to double bron- 
chitis,) sudden death may be the consequence, by robbing. 

26 



-102 BRONCHITIS. 



the patient of that strength, which is required in coughing, to 
-produce expulsion." In such circumstances, the bath ought 
to precede any attempt to use the lancet. 

And if the action of the heat, by expanding the external 
capillaries be attended with much inconvenience, the opera- 
tion should be suspended, five or ten minutes, and then be 
resumed and continued in a moderate way: — gradually in- 
creasing the heat, as the patient can bear it, till it produce its 
full effect : after which he may be bled with much benefit, 
in cases in which the practice would be fatal without the bath. 

In bronchitis we can scarcely ever determine the necessity 
or propriet3 T of bleeding, by the ordinary signs : because in 
some cases, the disease may be very extensive without violent 
symptoms : in others it may be very slight, and the symp- 
toms very severe, owing perhaps to a disordered state of the 
stomach and bowels, or to some other, perhaps slight cause : 
and it is of great consequence to know when to desist from 
further depletion. After becoming acquainted with the pow- 
erful effect of the bath in treating such cases, all these diffi- 
culties are greatly diminished, and the management of such 
affections is made easy, even in the hands of young physi- 
cians. In some instances, in cases of infants and young 
children, it is difficult to bleed from the arm. When this 
inconvenience occurs, it may be necessary to use cups or 
leeches ; and we will add, cups in peference to the leeches. 

"Next in point of importance to blood-letting, in pulmo- 
nary inflammation, stands antimony as a contra-stimulant.** 
So says our excellent author, Dr. Mcintosh. So said Cullen. 
Fordyce, &c. It is in like manner the opinion of the most 
enlightened of the faculty. And antimony is so generally 
beneficial, because it serves to prevent the accumulation of 
sensorial influence, which is consequent on blood-letting, and 
which would produce a reaction, marked with more power, 
than is consistent with the safety of the structures, when in a 
condition which may require depletion. If blood-letting be 
followed by an appropriate application of the alcoholic vapor 



BRONCHITIS. 403 



bath, the effect of this powerful agent on the capillary struc- 
tures, will prepare the way for the antimony; and the arrange- 
ment of medications, made according to this order, will be 
found more efficient. Moreover blood-letting will be found 
to be admissible, and the agency of antimony useful, if the 
bath be used also, in many instances in which their effect 
without the bath, would be deleterious. 

Colchicum has been highly recommended in this disease, 
and the effect of it is sometimes very serviceable. 

" Emetics are very useful in the first stage, and are abso- 
lutely necessary in the last, in order to clear the air passages, 
when the cough fails to do so ; and are more particularly 
serviceable, in childhood and infancy. 

The patient's bowels should be moderately free, but deci- 
sive purging may produce injurious prostration. 

" Expectorants and [the common] diaphoretics are more in- 
jurious than beneficial, except perhaps in chronic affections."' 

" Opiates are sometimes useful ; in the first stage, after the 
violence of the disease has been reduced by the lancet. In 
the last stage also, when there is considerable irritation and 
violent cough, which, if not mitigated, keeps the patient from 
sleep and wears him out." 

Blisters, when, in consequence of the depletions w T hich 
may have been found necessary, the skin is too much disabled 
to maintain the action of its capillaries, without the aid of 
contra-irritation. 

Special attention should be paid, to the condition of the 
skin, particularly to the temperature of the extremities, du- 
ring the whole period of the disease ; and the bath should be 
repeated, as occasion may require. The circulation of the 
blood should be continuously kept conspicuous in the vessels 
of the surface. The diet of the patient should be very light, 
avoiding every thing stimulating, until all inflammatory 
symptoms shall disappear. The patient should be kept quiet 
in bed ; every exertion should be avoided • even the exercise 
of the voice is injurious. 



404 CHRONIC BRONCHITIS. 



CHAPTER VIII. 

CHRONIC BRONCHITIS. 

" Like other chronic inflammations, this affection some- 
times succeeds to an acute attack ; sometimes, however, it 
takes place as a slow and insidious inflammation of the bron- 
chial membrane. This form of the disease may affect indi- 
viduals of all ages ; but it is most frequently met with in old 
people, and those who, by occupation, are exposed to the in- 
halation of dust. It sometimes succeeds also, to the eruptive 
fevers ; and frequently coexists with diseases of the heart. 

"It is occasionally mistaken for phthisis pulmonalis, and 
is one of the morbid conditions of the organs within the 
chest, which give rise to the symptoms denominated asth- 
ma ; and is likewise, a frequent cause of dropsical affections. 

" When the disease succeeds to acute bronchitis, the fever 
declines, but the pulse for some time continues frequent : the 
cough and difficulty of breathing continue, but they are al- 
ways relieved for a considerable time after a free expectora- 
tion. The patient still has night exacerbations, and disturbed 
sleep; which, however, gradually decline with the disease. 
The expectoration still copious, becomes opake, yellow, 
sometimes puriform, and has occasionally a greenish hue ; at 
last it diminishes in quantity. The appetite returns : and 
although weakened by night perspirations, which take place 
during the day also upon making the least exertion, the pa- 
tient is sensible of gaining some strength. Gradually all 
these symptoms cease> and some individuals seem to recover 
perfect health ; but in general throughout subsequent life. 



CHRONIC BRONCHITIS. 405 



exposure to night air, an easterly wind, or a hurried atmos- 
phere, occasions a renewed attack ; and with many, the same 
effect is produced by eating indigestible food, or by neglect- 
ing the bowels. Now and then, therefore, they become in- 
disposed ; the voice becomes hoarse ; the cough short and 
croupy; with more or less oppression in breathing, attended 
sometimes with febrile symptoms. 

In the chronic form of the disease, the expectoration takes 
place in a much shorter time from the commencement of the 
indisposition, than in the acute ; sometimes in a few hours ; 
it is viscid at first, but soon becomes copious ; and the patient 
is relieved by the discharge. One attack leads to another, 
until at last, the individual is always affected with some de- 
gree of difficult breathing ; he is almost constantly coughing 
and spitting; and is unable to lie in the horizontal posture ; 
he feels great difficulty in mounting a stair, and is said to have 
an habitual asthma. 

"In acute and chronic forms of bronchitis, cases now and 
then present themselves, in which the expectoration is very 
small in quantity. In this form, it has been denominated 
dry catarrh, and dry asthma." 

TREATMENT OF CHRONIC BRONCHITIS. 

Patients affected with this disease are liable to sudden at- 
tacks of acute inflammation, sometimes too, of congestion of 
the lungs, and sometimes, individuals become dropsical. 

In any such cases, general bleeding is commonly neces- 
sary. After blood-letting, apply the bath, so conducting the 
process as to make the application gradual. This will restore 
the vitality of the external capillary structures ; which done, 
will give the lungs the benefit of the restored functions of 
the skin, and do much in aid of the recuperative tendency 
which blood-letting will have set up, in the bronchial vessels. 



406 CHRONIC BRONCHITIS. 

The same should be repeated once or twice every twenty- 
four hours, for tfwo'orHhree days. 

If the symptoms should be at all obstinate, administer an 
emetic, say finely powdered lobelia inflata twenty grains : 
ipecacuanha twenty grains ; hot water four ounces. Of this 
give two table spoonsfull, and repeat one half the same quan- 
tity every fifteen, twenty, or thirty minutes, until it operates. 
This treatment might be repeated with advantage as often 
as the paroxysm shall recur, especially every night. It will 
greatly relieve respiration, and procure for the ,patient rest 
and sleep. If the difficulty of breathing return in the morn- 
ing, repeat the emetic, for the better effect of which the pa- 
tient may be prepared by a moderate repetition of the bath. 

In some cases the syrup of squills is useful : in doses of a 
tea spoon full repeated every two or three hours. As often as 
there shall be apprehension of a return of an attack, let the 
patient retire to bed, take a bath, and follow it by a dose of 
lobelia and ipecacuanha as advised above, and in most in- 
stances the paroxysm will be prevented. Perseverance in 
this mode of treatment will often effect a permanent cure. 



INFLAMMATION OF THE LARYNX. 407 



CHAPTER IX. 

INFLAMMATITION OF THE LARYNX. 

u This disease has a very close analogy to croup." It is a 
very common cause of death, in small pox and scarlet fever : 
and sometimes it follows measles. ¥ When this disease oc- 
curs in the acute form, it is known by a painful sense of 
constriction in the throat, which is increased by pressing the 
larynx. Speaking aggravates the pain, as does swallowing. 
The voice is hoarse ; the breathing soon becomes laborious 
and shrill, during the act of inspiration ; there is considera- 
ble heat of skin ; thirst ; frequency and tension of the pulse, 
and great anxiety. On looking into the throat, the fauces 
frequently appear to be swollen and turgid, and of a dark red 
color, or coated with lymph ; but this affection of the throat 
is not peculiar to laryngitis, or an inflammation entirely con- 
fined to the larynx. In some cases the epiglottis is involved, 
which renders the motion of the tongue painful. The pa- 
tient is constantly hawking, in order to clear the air passages, 
and occasionally spits up a small quantity of thick tenaceous 
mucous. As the disease advances, the face becomes swol- 
len and turgid ; it frequently has a livid appearance, and life 
is quickly destroyed by suffocation. Convulsions occasion- 
ally precede death. This disease sometimes runs its course, 
in from thirty-six to forty-eight hours/' The treatment 
proper in this affection, is so nearly similar to that which is 
proper in a case of spasmodic croup, which will be our next 
chapter ; that it is not necessary to say more than that the 
same course may be pursued till the patient shall be relieved. 



40S croup. 



CHAPTER X. 
CROUP. , 

This disease is of frequent occurrence among children re- 
siding in damp, bleak situations, on the sea coast, and in ma- 
ny places in the United States, which are considered health- 
ful. It consists of an inflammation of the lining membrane 
of the trachea, and is often complicated with bronchitis and 
laryngitis, the one running into the other, so much so. that 
frequently they cannot be distinguished. 

It is a disease almost peculiar to infancy and childhood. 
Inflammation of the larynx and bronchial tubes, occurs at all 
ages : croup seldom occurs to any after twelve years of age. 
One attack predisposes to another, but as age advances, this 
susceptibility goes off. 

Croup has been divided into three species : acute, chronic 
and spasmodic. It usually commences like catarrh, the 
symptoms being more or less severe, with some degree of fe- 
ver preceded by chilliness : the voice soon becomes hoarse; 
febrile symptoms increase : and in a day or two the breathing 
becomes more and more impeded, particularly during inspi- 
ration : at least the inspiration becomes stridulous, and the 
voice shrill ; a harsh dry cough exists from the beginning, 
and when there is any expectoration, it has more or less of a 
muco-puruient appearance ; sometimes small masses of lymph 
are discharged, which occasionally resemble portions of false 
rnembrance. As the disease advances, the expression of 



croui*. 409 



countenance becomes more anxious ; the lips and cheeks 
have a livjd and swollen appearance, alternating with a dead- 
ly paleness. The pulse is frequent and small, and some- 
times intermits. There is a prostration of strength with 
great restlessness ; although the surface of the body be gene- 
rally speaking hot, the extremities are frequently cold ; at 
last, the body is covered with a cold clammy sweat, and the 
child dies of suffocation. 

The cause of the disease is various ; sometimes children 
are cut off early, as if merely by want of breath, but in gen- 
eral, it lasts from two to three or four days. In chronic af- 
fections of the trachea, the symptoms are less violent and 
urgent, it is longer in progress, but the symptoms are the 
same j the breathing difficult and stridulous, and the voice 
shrill. 

It is in the chronic form of this disease, that the false 
membrane is sometimes formed in the trachea. This form 
comes on insidiously. The patient is considered to have ta- 
ken cold in the common acceptation of the term ; there is a 
slight difficulty of breathing, from the increased vascularity 
or congestion of the mucous membrane, producing a thick- 
ening of the membrane, and consequently a lessening of the 
calibre of the wind-pipe; gradually the same surface, in its 
extensions throughout the bronchi and air cells, becomes 
more and more congested, secreting a very viscid mucus, 
which becomes more and more dense, till the bronchi are 
choked and the child dies. 



TREATMENT. 

" This disease, of all others, requires promptness and de- 
cision, and activity in practice ; for if the false membrane be 
allowed to form, not above one case in the hundred will be 
saved. The worst instances are those in which a sore throat 



410 CROUP. 



has been neglected, and the inflammation has spread into the 
wind-pipe ; or those in which patients have labored under 
bronchitic symptoms for a week, or perhaps longer, before 
the disease has affected the trachea and larynx.'' Such cases 
are almost always fatal, and to these M. Bretonneau gave the 
name, diphthrite. When a child is attacked by this disease, it 
should be bled without delay, and to such an extent as to 
make a decisive impression. The blood-letting should be 
immediately followed by. an effectual use of the bath. If 
the bathing be not completely satisfactory, it should be fol- 
lowed by a dose of the tartrate of antimony ; two grains of 
which may be dissolved in two ounces of water. Of this 
preparation, a teaspoonful may be given every five or ten 
minutes, till its emetic effect shall be complete. Sometimes 
it is difficult to produce vomiting. In such an instance, the 
antimony should be used nevertheless. As a counter stimu- 
lant it is greatly beneficial, though it should uot produce its 
emetic effect. After a free use of the antimony, and the 
stomach shall have become quiet, two, three, or four grains 
of calomel should be given every second hour, so as to intro- 
duce from thirty to sixty grains in the space of twenty-four 
hours. When five or six doses of calomel shall have been 
administered, if the child should not be greatly relieved, 
repeat the bath, apply a large blister over the region of 
the stomach ; and whilst it chall be making its impression, 
repeat the emetic, which may be again followed with five or 
six doses of calomel. This kind of decisive treatment will 
commonly be successful, if commenced and carried out 
before the false membrane is formed — after its forma- 
tion, it is useless to torture the child with any severe re- 
medy. 

When the patient is less than eighteen months old, and it 
shall be found impracticable to bleed it from the arm, re- 
course should be had to the employment of leeches, a sufli- 



CROUP. 411 



cient number of which should be applied to the child's 
throat and neck, up and down the course of the trachea; six, 
eight, ten, or more, so as to make a complete impression. 
The lancet however is greatly preferable, inasmuch as it pro- 
duces the necessary effect more promptly ; and the sudden- 
ness of the shock not only makes the effect more visible, but 
on that account it is more useful. 

In that form of the disease which has been called spas- 
modic croup, it will be found that the use of the bath alone 
will often afford relief, and that the addition of blood-letting 
and an emetic will be completely effectual in almost every 
instance. It should be remembered, however, that no de- 
lay is admissible in a case of this sort, as death may en- 
sue within a very short time after the attack. In a 
word, no case of cold, threatening bronchitic or croupy 
symptoms, should be avoidably neglected j not even for 
one hour. 



412 HOOPING-COUGH. 



CHAPTER XI. 

HOOPING-COUGH. 

This disease, in its commencement, is almost always con- 
founded with a common slight cold. The time how long 
this mistake continues, varies very much ; in general it ex- 
tends through ten or twelve days. The cough, meanwhile 
is dry ; there is occasionally a sense of constriction in the 
chest, and a feeling of weight in the head. "The eyes are 
sometimes a little swollen and red, with frequent sneezing 
and involuntary tears; in many cases there is little or no 
fever, exeept in the night ; the bowels generally are out of 
order. We sometimes suspect the disease to be hooping 
cough because it is epidemic at the time, or because we no- 
tice the convulsive appearance in the paroxysm of coughing. 
At last the cough assumes a peculiar character; when this 
takes place, the disease is said to be in its second stage. It is 
characterized by a long and sonorous inspiration, producing 
a peculiar shrill noise, which is termed in common language, 
the whoop ; to which succeeds an expiration which is bro- 
ken by frequent fits of coughiug. No one that has seen the 
disease when fully formed, can mistake it. When the cough 
commences in slight cases, the features become a little swol- 
len, the face red, the eyes suffused with tears ; the cough, 
which is often interrupted by a long inspiration, is hoarse, 
the paroxysm ceasing with an expectoration more or less co- 
pious, frequently assisted by the act of vomiting, which dis- 
charges the contents of the stomach. As soon as this is ac- 
complished, children are commonly able to return to their 
usual amusements, and appear to suffer little or nothing un- 



HOOPING-COUGH. 413 



til towards the period of the next paroxysm. The appetite 
is in general good. The expectoration is at first slight, 
scanty and viscid ; but if the disease go on in a favorable 
manner, the discharge becomes more copious and less tena- 
ceous. Young children scarcely ever spit out the expecto- 
ration, unless during the act of vomiting ; it generally is 
swallowed as soon as discharged from the air passages. The 
patient generally is warned of the approach of the paroxysm 
by a greater or less degree of chilliness on the surface, and a 
tickling in the throat, immediately succeeded by a sense of 
tightness both in the larynx and chest, and a dread of suffo- 
cation, which induces him to fly to his nurse, or to lay hold 
on any thing within reach for support during the fit. Others 
seem to derive relief from lying all-fours on the floor, and 
when the discharge has taken place, they jump up and run 
about. In more severe cases, the sense of suffocation is 
dreadful; the respiration is much more impeded, the cough 
more intense and protracted, the features more swollen and 
of a livid color i, the eyes seem ready to start out of their 
sockets, the eye-lids much swollen, and their cheeks perhaps 
bathed in teats, till at last expectoration takes place, when 
the child will pant for breath, and be unable to return to play 
for a considerable time. The skin is above the natural tem- 
perature, particularly at night ; complaint is made of head- 
ache ; the appetite is bad, the bowels are more disordered, 
and flatulent distension aggravates the patient's suffering. 

The straining which takes place during the paroxysm, is 
sometimes so severe as to produce involuntary discharges of 
foeces and urine. It is no uncommon thing for a small blood- 
vessel to give way in the coat that covers the eye, producing 
ecchymosis ; sometimes, though rarely, a bleeding from the 
lungs, but very often a bleeding from the nose, which when 
it takes place in children of a. full habit, is considered a. use- 
ful occurrence. 

In the worst forms of the disease, fever is certainly pre- 



414 HOOPING-COUGH. 



sent, and the breathing is always more or less impeded, 
which shows that some mischief is going on internally. 
Fits of temporary loss of breath are frequent, which are very 
often mistaken for convulsions, and by them children are 
sometimes suddenly cut off. Sometimes convulsions do oc- 
cur and carry off the patient. 

THE NATURE AND SEAT OF- THIS DISEASE. 

" The essence of hooping cough consists in irritation and 
inflammation of the mucus membranes of the body, but more 
particularly >that of the air passages." The inflammation at 
the first is slightly sub-acute ; and there is therefore no heat 
of the skin, no discernible disturbance of the pulse, no thirst ; 
when the inflammation runs higher, then these constitution- 
al symptoms make their appearance. It begins like catarrh, 
and at the first cannot be distinguished from it ; the disease, 
when formed, comes in paroxysms. The paroxysm com- 
mences with a sense of coldness on the surface, making an 
irregular determination of blood upon the lungs. These or- 
gans become gorged, and the air is prevented from obtaining 
a free passage through the ramifications of the bronchi and 
air cells. Hence the difficulty of breathing, with tightness 
in the chest, and a sense of suffocation. The air passages 
become congested and inflamed ; the larynx and parts in the 
neighborhood principally suffer, and the injection of the ves- 
sels being suddenly increased at eve^y paroxysm, become 
swollen ; the rima glottidis, or opening in the windpipe, is 
diminished, producing the hoop, and the appearances which 
seem to threaten suffocation. 

TREATMENT. 

As in its first appearance it cannot be distinguished from 
catarrh, let it be treated as it it were the same affection. If 



HOOPING-COUGH. 415 



the symptoms be very slight, give a gentle emetic ; if threat- 
ening severity, let blood, give him an application of the bath 
and follow it with an emetic. If he shall not be relieved, 
and the symptoms become severe, repeat the same practice. 
If this kind of decisive treatment be performed as often as it 
shall be necessary, during the first stage, which is consider- 
ed to continue three weeks, the case will presently assume a 
mild aspect, and the patient will be safe. It should be re- 
membered, that his bowels should be kept gently free through- 
out the whole course of the disease. For this purpose, some- 
times, a moderate dose of castor oil may suffice. And com- 
monly the following preparation will be found particularly 
useful. Take bicarbonate of potas, one drachm, powdered 
ipecacuanha, fifteen grains, water, four ounces. Of this a 
teaspoonful may be given to a child two years old, every 
second hour, till it shall produce the necessary effect. 

After the disease shall have assumed a mild and settled 
form, if by taking fresh cold, or from whatever other cause, 
the symptoms should again become severe, let him again be 
bled, bathed and vomited as before, with one variation only. 
In the commencement, the vomiting had better be produced 
by an appropriate dose of tartrate of antimony, in the later 
stages by a little ipecacuanha. 



416 PNEUMONIA. 



CHAPTER XII. 

pneumonia, or inflammation of the lungs. 

This disease has been denominated peripneumonia and 
pneumonitis ; and when attended with a complication of in- 
flammation of the pleura, it has been designated by the term 
j^leura peripneumonia. 

'•Like all other acute diseases, pneumonia commences 
with shivering, followed by a hot stage, which is generally 
pretty violent, unless the inflammation be congestive, when 
coldness predominates. There is more or less difficulty of' 
breathing, and the number of respirations considerably ex- 
ceeds twenty in a minute ; and twenty may be considered as 
the natural standard. The breathing in some cases is very 
laborious ; but we must be very careful not to suffer our- 
selves to be led astray by the account which the patient may 
give respecting this point. Often, when the respiration is 
short and hurried, he will assure us that he does not feel the 
least impediment. Pain is not a well marked symptom in 
inflammation of the substance of the lungs : the patient com- 
plains rather of a tightness in the thorax : and when pain 
exists, it is in general dull instead of sharp. The cough is 
short and perpetual, and does not come on by fits ; it is dry 
at the commencement, and continues- to be very distressing 
and obstinate. The expectoration is scanty, viscid and dis- 
colored, from an admixture of blood ; sometimes it is bright, 
like red currant jelly; but in general it is rusty looking, re- 
sembling brickdust intimately mixed with viscid mucus : it 
is very tenaceous, and adheres firmly to the sides of the ves- 



PNEUMONIA. 417 



sel into which the patient spits ; the expectoration, though 
rarely, is sometimes fetid. A gangrenous odor is perceived 
when the case terminates in gangrene. 

In this disease the pulse is variable, and therefore to an in- 
experienced physician, an uncertain guide. The effect of 
depletion is different according to the condition of the patient. 
If his pulse be full because he is in a plethoric state, and conges- 
tion of the lungs have already occurred, well conducted blood- 
letting will diminish the frequency of the pulse and lessen the 
difficulty felt in respiration. If the pulse be small, tense and 
frequent, it will become fuller, stronger, less tense and fre- 
quent, after the depletion. The skin in some instances is 
hot and dry ; and in others below the natural standard. The 
tongue soon becomes parched and dusk colored. A dry and 
glossy tongue always indicates danger, as does delirium also 
if it occur in the early stages. 

In acute inflammation of the lungs, the part affected is red. 
and the parenchyma, or structure of the affected portion is 
more dense than natural, being overcharged with blood. In 
the second stage the structure becomes solidified, or in the 
language of Laennec, it is hepatized. 

TREATMENT. 

In treating pneumonia, the lancet is to be used freely, and 
may be repeated and employed later in the disease than in 
bronchitis. If the; pulse be compressible and not tense, the 
blood on the first bleeding should be permitted to flow till 
the pain abates, or till the vascular action is rendered mode- 
rate. The patient should then be carefully watched until 
the pain and difficulty of respiration begin to return, when, 
on careful examination the pulse will be found to be tense. 
Whenever this state of things occurs, the bleeding should be 
repeated, and the blood made to flow untii the tension for the 

27 



418 PNEUMONIA. 



time being, is corrected. After this state of things shall have 
been accomplished, the vapor bath should be used to the 
extent of perfect sweating, and the eighth part of a grain of 
tartarized antimony in an ounce of water, be repeated every 
second, hour till a return of the exacerbation ; which some- 
times occurs very soon after a proper application of the heated 
air. This circumstance would be considered by one not ac- 
quainted with the action and power of the remedy, as evi- 
dence of the impropriety of the treatment- On account of 
this fact, it has many times been condemned and laid aside 
as a dangerous remedy. The truth in the case is, that it is 
a very favorable symptom, and gives the most trustworthy 
proof, that the bleeding ought to be again immediately re- 
peated, till the vascular action shall satisfactorily succumb. 
When the case shall have been conducted to this point, the 
exacerbations will recur at regular periods, twice in twenty- 
four hours, one from ten to twelve o'clock midday ; another 
from ten to twelve at midnight ; and at every recurrence, the 
patient should be bled till the tension of the pulse shall be 
corrected. In the mean time, a strict regard should be had 
to the state of the patient's skin; and whenever it is 
about to assume a permanently pallid hue, a large epispas- 
tic should be applied, and the blistering diligently continued, 
until the pain and all difficulty of respiration shall be entire- 
ly removed. 

When the attending physician shall become familiar with 
the use of the bath, regarding the directions furnished on 
that subject, he will find that once every day, it may be 
employed with singular advantage, for the purpose of main- 
taining the vitality of the skin, and more effectually se- 
curing the intention for which the epispastic is applied. 
The number of bleedings, and the times of repetitions will 
be known by the returns of the paroxysms ; and the tension 
of the pulse. 



PNEUMONIA. 419 



In a case of this sort, if the tension of the pulse be not com- 
pletely subdued, it will change and assume the corded state. 
Any appearance like conval-esence, with a pulse of that descrip- 
tion, will be illusive, and a sub-acute irritation will fol- 
low. When such an occurrence befals a case, it is com- 
»monly said to be a relapse. The capillary vessels which 
had been in a state of congestion, though partially re- 
lieved by insufficient depletion, so soon as the arterial ac- 
tion gains a little strength by repletion, are again injected, 
as they were in the commencement of the attack, and some- 
times even worse. 

It is very desirable that this pathological fact should be 
particularly noticed, not only in respect to the safety of per- 
sons that may be subjected to the disease under consideration, 
but also that of all others who may become the subjects of 
inflammatory disease, of whatsoever particular description ; 
since the same danger awaits them all. For many years we 
have had our attention turned to this subject, and have no 
recollection of an instance of chronic disease, either of the 
thoracic or abdominal viscera, in which the corded state of 
pulse was not one of its pathognomic symptoms. And we 
never could succeed in effecting satisfactory relief in such 
cases, without some depletive measure. 



420 PLEURISY. 



CHAPTER XIII. 

PLEURISY. 

Pleurisy is generally ushered in by a cold stage of greater 
or less severity. The patient complains of fixed pain in the 
side, over which he can place his finger, which he describes 
as a stitch, catching and interrupting his breathing every 
now and then, particularly when he fetches a deep breath. 
The pain is sometimes very acute and lancinating, as if stab- 
bed with a sharp instrument. The breathing is difficult and 
anxious; short, but at the first not so heavy and oppressed 
as in inflammation of the lungs. There is also cough, which 
aggravates the pain very much ; the expectoration is thin 
and watery, differing from that of pneumonia and bronchitis : 
the pulse is quick and tense, and the heat of the skin is more 
intense than in inflammation of the lungs. The skin is hot- 
ter over the chest, and particularly immediately over the seat 
of the pain ; and external pressure made at that point, pro- 
duces much inconvenience. The tongue, however much 
furred, soon becomes dry. The urine is scanty and high 
colored. And some patients affected with this disease be- 
come delirious. 

There is a painful affection, often thought to be rheuma- 
tism of the muscles between the ribs, which is termed pleu- 
rodynia, and which is so much like pleurisy as to make it 
difficult to distinguish the one from the other, judging by 
external appearances. There is however a difference in the 
state of the pulse. 

In pleurisy, in its commencement, the pulse is always 
tense. In the other affection, although the pain may be felt 



PLEURISY. 421 



intensely at every breath, still the pulse is readily compres- 
sed. The one is inflammatory, the other is neuralgic. 

TREATMENT. 

If the patient be of full habit, and accustomed to labor, let 
him be bled decisively, from one to two pounds. After one, 
two or three hours, apply the vapor bath intensely, so as to 
procure a free perspiration, with a flushing in the face, and a 
considerable throbbing of the temples. If the pain return, 
apply the bath a second time, to the same extent. General- 
ly, by this treatment the pain will be removed ; if not, let 
him be bled a second time. If the case shall have been 
neglected, and an inflammatory condition established, it may 
be necessary to apply ten or twelve leeches over the seat of 
the pain. Or four or six cups might answer as well. If the 
pain be not speedily corrected, it may be concluded that an 
irritation partaking more or less of a chronic form has occur- 
red, and the case will require the use of blisters, digitalias, 
antimony, opium and calomel, to be employed according to 
the directions given in respect to those articles. 

In a case of pleurodynia, commonly a decisive application 
of the vapor bath, followed by a dose of do ver's powder, 'will 
mitigate the violence of the pain, and a repetition of the same 
treatment will often effect a cure. If, however, the pain 
continue obstinately to resist this treatment, a moderate blood- 
letting may be associated with a farther repetition of the bath, 
after which an epispatic eight by ten inches, will probably 
finish the cure. In either case, food must be very sparingly 
used, and the patient be kept quiet, and without exercise for 
several days. In many instances it is an excellent plan to 
keep the patient slightly under the influence of antimony; 
which will prevent him from feeling much inclination to eat, 
speak, or sit up. 



422 ROSEOLA NETTLE RASH. 



CHAPTER XIV. 

"ROSEOLA— NETTLE RASH. 

This disease is a febrile eruption, which is distinguished 
by circular elevations of the cuticle, of a red color, with a 
white spot in the centre, which are commonly called whelks. 
This is the most frequent appearance of the eruption. Some- 
times the whelks are not red, but whiter than the surround- 
ing skin. This eruption is often preceded by marks indica- 
tive of gastro-intestinal irritation and fever. In such instan- 
ces, the patient is affected with restlessness, oppression, lan- 
gour and loss of appetite, his tongue foul, with redness at its 
tip and around its edges. Sometimes the eruption is gene- 
ral, accompanied by great heat and itching of the skin, by 
which, however, the internal distress is relieved. In some in- 
stances the rash appears only when the patient is heated by 
exercise, or by wine, or when he is undressing himself; and 
it is often excited in a fresh part by friction or scratching. 
This disease is often produced by eating oysters a little stale, 
lobsters, crabs, shrimps, and the mutillus or sea muscle. In 
consequence of some peculiar idiosyncracy, some are simi- 
larly affected by eating mushrooms, honey, almonds, the 
kernels of stone fruits, strawberries, &c. In these instances 
the operation is almost instantaneous, and the symptoms very 
violent for several hours. When this affection occurs, it may 
continue for an indefinite length of time, and may be repro- 
duced in particular constitutions, every time the stomach is 
disordered. 



ROSEOLA NETTLE RASH. 423 



TREATMENT. 



The patient should avoid all articles of diet which he knows 
from experience, can produce the disease. The stomach, &c. 
that is, the internal and the external surfaces, are the struc- 
tures which are affected by the nettle rash. 

Use the compound blue pill for the correction of the one, 
and the vapor bath for that of the other. 

As in every other eruptive disease, if it be at all severe, it 
will involve the vascular structures, and be accompanied by 
more or less frequency of the pulse. If there should be pre- 
sent circumstances that may be thought indicative of too 
much fever to trust the case without decisive interference, 
by no means have recourse to the use of the lancet. We 
once visited a case of this sort, in which after an imprudent 
blood-letting, the disease had left the skin and determined 
its violence on the stomach and bowels, assuming the appear- 
ance of an incorrigible cholera morbus, which in a few hours 
terminated in death. Such a case of fever might often be 
subdued by a prudently administered dose of ipecacuanha: 
but depletion, even by an emetic, might be followed by trou- 
blesome introversion. 



424 ERYSIPELAS. 



CHAPTER XV. 

ERYSIPELAS, OR ST. ANTHONY'S FIRE. 

Saint Anthony's fire is frequently preceded by a fever. A 
sore throat is commonly one o"he premonitory symptoms. 
The patient feels ill; chilly, weak and languid; and often 
drowsy. At length his sensations are like ague, and his 
pulse very frequent, which may continue some hours before 
the eruption makes its appearance. It is not uncommon for 
it to be accompanied by a disturbance of the bowels, with 
nausea and vomiting ; and sometimes by diarrhoea. Then 
some part of the face, most commonly one side of the nose, 
or one cheek, or the rim of one of the ears, begins to feel hot, 
stiff and tingling, which is soon of a deep continuous red co- 
lor, and swelled and hard. The redness and swelling, with 
greater or less rapidity, continue to spread. The edges of 
the redness are a little raised above the level of the skin. 
Thus it progresses, and if not arrested, it spreads until the 
whole face or scalp, or both, are in a state of burning inflam- 
mation. The lips, swell, the cheeks are enlarged, the eyes 
closed by the thickening of the eye-lids, producing a degree 
of deformity, unequalled by any other disease but the small 
pox. It commonly begins on the face, and spreads back- 
wards over the forehead to the hairy scalp ; sometimes 
quite down to the neck and shoulders. Sometimes the in- 
flamed surface is covered with small blisters. In many in- 
stances the inflammation is quite superficial, in others it dips 
through the skin, and affects the cellular tissue, under the 



ERYSIPELAS. 425 



skin. When this occurs, it is followed by suppuration, and 
sometimes a sloughing of the part so affected. 

TREATMENT. 

In cases of erysipelas, as in every other disease, it is im- 
portant that it should be met at the onset. So soon there- 
fore, as there is cause to apprehend an attack, the patient 
should take a dose of ipecacuanha, especially if his stomach 
or bowels are not in good condition. Then let him be treat- 
ed decisively with the vapor bath, regarding the same in- 
structions which have heretofore been given for the treat- 
ment of other affections. In addition to the general treat- 
ment, let a shovel of hot coals be held to the inflamed part, 
so as to heat the surface intensely. And this local applica- 
tion of heat should be repeated, as often as the return of the 
burning peculiar to the disease, shall make it necessary. 
The patient need not fear the use of the burning eoals. 
Arrd as soon as he shall have proved how much relief and 
comfort are afforded by the treatment, he will call for its re- 
petition. 

If these two methods of applying heat should not be com- 
fortably effectual, it iuay be coucluded that so much general 
inflammatory action exists in the case, as to require blood- 
letting ; which being, performed, repeat the bath and pro- 
ceed on with the shovel of coals as above advised. 



426 SCARLET FEVER. 



CHAPTER XVI. 

SCARLET FEVER. 

In eruptive fevers, as well as in other forms of fever, there 
are the two important distinctions. The one, congestive, 
the other inflammatory. 

In the congestive form of this disease, the patient com- 
plains of a sense of heaviness or weight in the breast ; and of 
a weakness so great, as to find it inconvenient to sit up. He 
feels more or less chilly. His face is pale, his features 
shrunk, his eyes hollow and dull; his surface cool, particu- 
larly, his extremities will be cool, whilst his body is hot ; his 
breathing is performed with difficulty, his pulse in most in- 
stances is soft and weak, but sometimes cases occur, in which 
the pulse is strong ; his tongue is small and covered with a 
whitish deposit of lymph. There is universal prostration, 
with headache or a complaint of weight on the top of the 
head, and a difficulty in swallowing. On examining the 
throat the parts appear somewhat swollen and of a dark color, 
and if there should be ulceration, the sores will be ash col- 
ored and look indolent. Sometimes a case of simply inflam- 
matory scarlet fever will unexpectedly take on all these ap- 
pearances, upon a sudden disappearance of the rash ; and 
again the signs of congestion have all disappeared upon the 
reproduction of the red appearance of the skin. 

It is the congestive form of scarlet fever which is most 
usually attended by convulsions. And in the worst cases of 
it, there appears to be no redness of the skin. The disease 
commences in such cases, with vomiting and purging, which 
continue in defiance of every effort to arrest them. Instead 



SCARLET FEVER. 427 



of being red, the skin presents a livid, death-like appearance j 
becomes cold • the features shrink and the patient dies in ten 
or twenty-four hours, in a state of restless delirium. Some- 
times symptoms like croup take place, which is generally a 
precursor of death. This disease seldom occurs in a purely 
congestive form. It commonly exhibits a combination of 
inflammatory, with the congestive symptoms. 

The inflammatory form of scarlet fever commences with a 
chill, or sometimes with only a slight chilliness, which, as in 
other fevers, is followed by more or less heat, want of appe- 
tite, thirst, inability to sleep, headache, some degree of sick- 
ness at the stomach, and a sense of weight in that region ; 
the tongue at first slightly loaded, red, with raised papilla? ; 
or much loaded with a yellow fur, red at the tip and round 
the edges, but sooner or later, it takes on an uniform shining 
red color. It sometimes is fitly compared to a piece of raw 
beef j if the case be protracted and typhoid, it then becomes 
dry, brown and cracked. Soreness of the throat is often the 
first symptom. On inspection the tonsils and palate are either 
much swollen or inflamed, or of a dusky 'hue, and in bad 
cases, are ulcerated. Sometimes, in consequence of subacute 
inflammation in the larynx or bronchial tubes, the case will 
be attended by difficulty of breathing, cough and hoarseness. 
Sometimes these appearances exist from two to five or six 
days, before the redness peculiar to the disease, makes its 
. ppearance. In some of the milder instances, the eruption 
is the first symptom. In general, it makes its appearance on 
the fourth or fifth day,* when it will be seen on the face and 
neck, after which, in the course of twenty-four hours, it be- 
comes generally diffused. This partial description is suffi- 
cient for our purpose. 

TREATMENT. 

In this form of fever it is highly important, that suitable 



428 



SCARLET FEVER. 



measures be taken without delay. If possible, it ought to be 
treated in anticipation. With the discretions given in respect 
of the use of the vapor bath, it can never do serious injury. 
So soon, therefore, as the disease is thought to have taken 
hold — we mean in the time of the predisposition, and on the 
first complaint of the patient — treat him with a decisive bath. 
This will disclose the true state of the system. If the case 
be inflammatory, the ordinary symptoms of inflammatory 
diathesis will be evinced. These will be corrected by an 
appropriate blood-letting, and the case will prove itself to be 
mild and manageable. In scarlet fever not only the throat, 
but the whole extent of the mucous surfaces is in an irritable 
state and is readily irritated by the use of any drastic or harsh 
remedy. It is therefore a great advantage, that a proper 
management of the external surface will render it unneces- 
sary to irritate the internal, that is the mucous surface, by 
ordinary medication. If. however, the agency of the bath 
be followed by too much vascular action, there need be no 
hesitation as to the propriety of using the lancet. We feel 
very confident, that the number of unmanageable cases will 
be greatly lessened, by the practice here recommended. 

If an artificial evacuation of the bowels shall be deemed 
necessary, an aperient of the mildest kind is to be preferred : 
such as elder blossom tea, sweetened with manna: or a por- 
tion of sweet oil. to which, if found necessary, a tea spoonful 
of fresh castor oil may be added. 

In any case, howsoever it may have been treated, if the 
eruption take on a livid hue at any stage of the fever, let the 
bath be repeated, and when retired, let pains be taken to keep 
up the excitement of the external capillaries, by using large 
cloths wrung out of hot water, to be laid over the entire 
trunk of the body, and jugs or bottles filled with hot water 
may be kept continually at the patient's feet : remembering, 
that this kind of management, when required, must be con- 



SCARLET FEVER. 429 



tinuous, till the necessary correction of the skin shall have 
been secured. 

The best wash for the throat, is pure warm water. When 
it shall have been ascertained, however, that ulcers have 
been formed, a solution of the nitrate of silver,* may be ten- 
derly applied, twice in twenty-four hours, and continued, 
till the sores shall present a healthy appearance. Afterwards 
continue the warm water without addition. If the skin be 
kept in proper condition, the patient may safely be indulged 
in a moderate use of cold water, and if convenient, ice may 
be added. His diet should be exceedingly light, and small 
in quantity. 

During the time of convalescence, he should carefully 
avoid exposure to cold or wet weather. After an eruptive 
fever, the capillaries are feeble in their vascular action and 
in their functions. Exposure, therefore, readily affects them 
injuriously, and all the mischiefs commonly ascribed to ta- 
king cold, may be readily induced. 

# Ten grains of the nitrate of silver to an ounce of pure water. 



430 



MEASLES. 



CHAPTER XVII. 

MEASLES. 

This disease is a fever with an eruption. Like other forms 
of febrile affections, it appears in two varieties ; the conges- 
tive and the inflammatory. 

In the first, the vascular action of the system would ap- 
pear to be inconsiderable and the eruption quite trivial. The 
pulse appears to be feeble; but the debility is indirect and the 
system oppressed. In most instances of this sort, the pulse 
is frequent, the eruption slow in making its appearance, 
and when it begins to manifest itself, the redness and heat 
which are very conspicuous in the inflammatory variety of 
the affection, are scarcely and sometimes not at all discerni- 
ble. The functions of the brain become disturbed, the re- 
spiration oppressed ; the leading features of congestion are 
soon exhibited, and if suitable measures be not timely taken, 
patients so affected will generally be lost. 

The inflammatory variety, is the one we most commonly 
meet with. It commences with the usual eruptive fever, 
marked in its onset by chilliness, depression and debility. 
The fever is accompanied by a dry cough with hoarseness ; 
frequent fits of sneezing, with every appearance of nasal ca- 
tarrh. He complains of giddiness and pain in his forehead, 
and often also in his back ; the pulse in some cases is small, 
tense and frequent ; in others full, tense and frequent; and 
often, it is irregular and oppressed ; the bowels generally are 
constipated and the evacuations offensive. In the course of 



MEASLES. 431 



the second, third or fourth day, the symptoms become more 
aggravated ; light offends the eyes, which are red, watery 
and inflamed ; the difficulty of breathing is much increased ; 
there is a tightness felt across the chest and a painful'weight 
at the prcecordia. The eruption makes its appearance, first 
on the face and neck ; in twenty-four hours, it shows itself 
on the breast, and afterwards' gradually extends over the 
whole body ; it consists of small red pimples, a little raised 
above the level of the skin, resembling fleabites ; these ex- 
tend, forming little patches which take on shapes slightly 
imitating the figure of new moons, of the fourth or fifth day 
after the change. 

As the eruption is about to make its first appearance, the 
patient in some cases is seized with violent sickness and 
vomiting ; sometimes with convulsions ; all of which abate 
if the eruption comes out freely. 

TREATMENT. 

The congestive form of fever which sometimes occurs in 
the -commencement of an attack of measles, ought almost 
invariably to be met by letting blood freely from the arm. 
After the bleeding, the bath may be used decisively. By 
this treatment, the system will commonly be adjusted ; and 
the case will progress as in an instance of the ordinary and 
mild inflammatory distinction. But in this, as in every other 
congestive fever, it is important to begin early ; permitting 
no time to elapse after the appearances indicative of conges- 
tion, begin to occur. 

There may be instances of intermediate description, which 
claim our attention in this place. These are ill longer than 
usual, generally five or six days before any eruption appears, 
having the usual symptoms which attend catarrh ; great de- 
bility and drowsiness ; frequent vomiting and discharges from 



432 MEASLES. 



the bowels, which are sometimes bloody; pulse frequent, 
tongue white, the skin rather cool. And when the rash ap- 
pears, it is less distinct, less elevated, and of a darker color. 
After it retires, the patient is more or less distressed with 
cough, difficulty of breathing, diarrhoea and retching to vom- 
it, and if not corrected, soon assumes all the appearances of 
a typhus fever. In a case like this, we would first employ 
the bath, which will at once produce a favorable effect. If 
symptoms indicative of too great vascular action should fol- 
low, a blood-letting will immediately subdue it, and a repe- 
tition or two of the bath, will remove all the alarming symp- 
toms. In the slighter forms of this disease, as in scarlet fe- 
ver, very little medication is necessary. Confinement to one 
room, gentle laxative medicines and a low diet, will gene- 
rally answer every useful purpose. In the commencement, 
even in the simply inflammatory form of measles, it is proper 
and necessary to let blood, if the eruptive fever rise too high. 
And when the branny scales begin to form on the surface, it 
is often greatly beneficial to repeat the depletion. About at 
this stage of the disease, the lungs or bowels may be threat- 
ened with danger. In any such instance, the bath may be 
used with great benefit. Let the bathing be decisive. As 
a suitable aperient, we would recommend the milk of sul- 
phur, of which a teaspoonful may be given and repeated, as 
there may be occasion. It may be given in a little molasses : 
or if it be preferred, in a little new milk. The use of the 
sulphur will keep the bowels in good condition, and give 
greater security for a healthy convalescence. 

In any protracted -case, the circumstances and appearances 
which occur in other forms of fever, may be looked for in 
like manner in measles ; and require the same kind of treat- 
ment, not regarding the fact, that the disease in the first in- 
stance, was called measles. One peculiarity which is com- 
mon to this and all the eruptive fevers, may be noticed. The 



MEASLES. 433 



eruption in the degree of its extent and severity, leaves the 
capillary vessels of the surface in an enfeebled condition, 
making it necessary to guard the skin more carefully, and 
for a longer period, than is required in other instances of 
fever. The common opinion that measles can fall upon the 
lungs or bowels, is altogether erroneous. The truth of the 
case is, that the disabled state of the skin, makes it more lia- 
ble to be affected by cold or wet weather ; and when the 
lungs or bowels become diseased after an eruptive fever, the 
affection is consecutive on the debility induced by the fever, 
and is not produced by the falling inwards of the imaginary 
peccant matter thought to be contained in the eruption. 

If this plan of treatment, which we have adopted and 
found successful in every instance, should become general, 
many useful lives will be preserved by it. There are so 
many who fancy themselves good judges in all cases of mea- 
siesj whose leading opinions are very erroneous, but who. 
nevertheless, have sufficient influence to be trusted, that 
sooner or later, hundreds and thousands, are induced to take 
their prescriptions and postpone their applications to men of 
real pretensions, till irretrievable mischief is done. Many 
cases of consumption have been the consequences in instances 
of adult patients. Tabes messenterica has often been setup 
in cases of children. 



28 



434 SMALL POX. 



CHAPTER XVIII. 

SMALL POX. 

We have introduced small pox, that we might have occa- 
sion to call attention to the important fact, that the eruptive 
fever which ushers in this loathsome and destructive disease, 
is subject to all the various and perplexing distinctions, which 
are observed to take place in scarlet fever and measles, and 
may be met with the same kind of treatment. If it be inflam- 
matory, blood-letting is indispensable. We have let blood four 
times, abstracting one pound at each time, in the course of 
the day preceding the eruption. But for this, the case would 
have been congestive. Let the rules for blood-letting be 
regarded, and repeat according to the exigencies of the case ; 
and if there be occasion, secure reaction, by the aid of the 
bath. This may be done without fear. If in consequence 
of existing debility, the eruptive fever be imperfectly exhib- 
ited, pursue the same course. By the agency of heat, externally 
applied, the true condition of the case will be developed. If 
the debility be indirect there is corresponding danger of con- 
gestion, and the bathing must be followed by blood-letting, to 
be repeated or not, as the case shall require. If in view of the 
previous health of the patient, and of other circumstances 
which may be taken into the account, the condition of the 
patient shall be found to be, that of direct debility; the bath 
should be used and its effect sustained by a free use of an 
infusion of Virginia snake-root tea : and this practice should 
be repeated, until the eruption shall be perfect. As in the 
other eruptive fevers, much medication is injurious, so also in 



SMALL POX. 435 



small pox. And as in the convalescence of measles, scarlet 
fever, &c, much care is necessary to avoid being chilled, so 
also and more particularly in the case now under considera- 
tion. There need be no hesitation in respect of using the 
bath. It is safe in the beginning ; it corrects a premature 
recession or sinking of the pock j and it corrects a tendency 
of the circulation to turn upon the lungs or bowels at the ter- 
mination of the disease. 

In a case of small pox, if it be very severe, mischief can 
be done by the severity of the first exacerbation, in two ways. 

In an instance of fatal scarlet fever, on an examination 
after death, the meninges of the brain are commonly found 
to be in the condition of incorrigible congestion, the effect of 
the first day's fever. A similar mischief can be done in a 
case of small pox. The decrepitude of the brain when in- 
duced, will so much enfeeble the system, that the skin will 
be disabled and the injury done to it by the eruption, leaves 
it in a condition readily subject to gangrene. And in fatal 
cases of the disease when confluent, the skin dies before any 
other part of the body. A timely blood-letting will prevent 
both these mischiefs. 

We deem it unnecessary to add further remarks, as vacci- 
nation, employed as it ought to be in every family, will either 
prevent or greatly mitigate the dangers attendant on this for- 
midable pestilence. 



336 mumps. 



CHAPTER XIX. 

MUMPS. 

An inflammation of the parotid glands, which are situated 
below the angle of the lower jaw, near the ear, is called 
mumps. It seems to be contagious, as it occurs but once in 
the course of life. It is sometimes painful, but almost never 
dangerous. It sometimes appears to fall upon the testicle in 
the male and upon the breast of the female. 

If there should be much pain, it would be beneficial to let 
blood, apply the bath, and administer a gentle aperient. 
Also a shovel filled with red hot coals may be held near the 
painful tumor, whilst an application of camphor and oil may 
be made to the part affected, rubbing it in gently with the 
hand. The same kind of treatment will be proper in respect 
of the testicle or breast, in those cases which may require 
that sort of treatment. The hot coals applied in the same 
manner, will relieve sore throat or other local affections, 
whether boils, sprains, bruises, inflamed cuts or sores, and 
carbuncles, &c. To be beneficial, however, the coals must 
be held near enough to produce intense heat and redness of 
the skin. 

A case of mumps might occur in which the fever would 
be sufficiently intense to require attention. In an instance 
of that sort the patient should be bled and then treated with 
the bath. 



GASTRITIS. 437 



CHAPTER XX. 

GASTRITIS, OR INFLAMMATION OF THE STOMACH. 

Inflammation of the stomach is known by a burning pain 
in that organ, which is increased by pressure ; a constant 
desire for cold drinks, w'hich are vomited almost as soon as 
swallowed ; sickness at the stomach and a desire to throw up 
are incessant ; the surface over the epigastric region is com- 
monly very hot, whilst at the same time, the 4 extremities are 
cold or nearly so. There is in some instances, a sore throat, 
with appearances of inflammation on the fauces. Hiccup is 
one of the most troublesome symptoms. The tongue, though 
not always, is commonly red at the tip and round the edges, 
and is covered with a filthy coat in the middle and towards 
trie root. In some cases of long standing, it is red, glazed 
and smooth. This last appearance, however, is more fre- 
quently a symptom of inflammation of the lower intestines 
than of the stomach. Breathing is anxious and quick ; the 
pulse small and tense, often fitly compared to a tightly drawn 
cambric thread. Great restlessness with rapidly increasing 
prostration of strength. The patient complains heavily. 
Towards a fatal termination, his features shrink and he lies 
on his back. The bowels are commonly in a state of con- 
stipation. At the first he vomits what he drinks and little 
else, except occasionally, some bilious matter. Generally the 
vomiting prevails through the whole course of the complaint, 
till the black vomit closes the scene 



438 GASTRITIS. 



TREATMENT. 



Let blood till the tension of the artery retires. -The quan- 
tity of blood which is necessary, can be known only by the 
effect of the depletion on the pulse. After a decisive blood- 
letting, apply the bath. In this case, it should be very hot. 
After the bath make hot applications directly over the seat of 
the distress. So soon as the tension of the pulse and the dis- 
tress of the stomach recur, repeat the bleeding and the bath, 
as before. Then apply a large epispastic over the abdomen, 
ten inches by twelve, or even larger if the case be severe. 
Again a third or fourth time, repeat the bleeding and the 
bath, if the state of things requires it. Decision is necessary. 
The disease is a very dangerous one, and requires a treatment 
corresponding to its severity. 

After the violence of the disease shall have been overcome, 
care is necessary in respect to diet, exercise and exposure. 
A light diet, passive exercise only, and that in moderation, 
avoiding exposure to cold or wet weather, are the points to 
be regarded during the convalescence. 

The patient should drink cold water, in which should be 
dissolved a little gum arabic ; or it may be made mucillagin- 
ous by steeping it in a handful of the pith of sassafras wood. 
If it be convenient, the water may be made cold by adding 
ice. The quantity taken at a time should be small, but may 
be frequently repeated. 



ENTERITIS, ETC. 439 



CHAPTER XXI. 

ENTERITIS AND PERITONITIS. INFLAMMATION OF THE 
MUCOUS MEMBRANE OF THE BOWELS. 

Inflammation of the mucous membrane of the bowels, 
generally comes on insidiously. It begins with symptoms 
of fever, or it may seem to be, as if a symptom of subsequent 
occurrence, discovering itself, after fever shall appear to have 
been established. Pain is often slightly felt, in comparison 
with that, which generally attends peritonitis. If the pain 
be considerable about the navel, it indicates that the inflam- 
mation is seated in the small intestines. Cold drinks aggra- 
vate the distress, as does any article of diet, except rice wa- 
ter, chicken water or some such very light fluid material. 
The pulse varies at different times in the day. It is com- 
monly frequent but not so tense as in peritonitis. The skin 
is hot and dry through the day and night, till towards morn- 
ing, when it becomes moist, and then the patient enjoys 
comfortable sleep. The tongue presents various appearances 
in different patients. In general, it is red at the tip and 
round its edges ; but sometimes it will be clean, at others 
foul, and both without redness. Sometimes it is entirely 
red, sometimes raw and smooth. This last, reports great irri- 
tation. If the upper parts of the intestines be affected, there 
will be nauseau -and an inclination to vomit. If the lower 
parts are affected, there will be more or less diarrhoea and 
considerable discharges of flatus. A twisting pain coming 
on and retiring at intervals, of an hour or half hour, or less, 
is an indication of distress in the colon, and is followed by 
an irresistible desire to go to stool. If the rectum or lower 



440 

end of the intestine be affected, the patient has almost a con- 
tinual desire for the close stool, and passes nothing but bloody 
mucus or some small lumps accompanied with much flatus. 
It must be remarked here, that the discharges above descri- 
bed, are always present when we denominate the disease di- 
arrhoea or dysentery; but the inflammation of the mucous 
membrane may exist, and these two symptoms not be 
manifest. 

TREATMENT. 

If the symptoms be severe, a decisive blood-letting will be 
necessary; then apply the bath. The blood-letting should 
be extended until the tension of the pulse be made to yield. 
If the case be mild, a decisive bathing may be sufficient 
without loss of blood. After the bleeding and bathing, make 
warm applications to the abdomen — a large flannel cloth 
wrung out of hot water, and renewed every half hour. If 
the pain or vomiting, &c. return, repeat the bathing, and if 
the case be violent, the bath may be preceded by a second 
bleeding. 

After having removed the violent symptoms, the bowels 
may be opened by the use of some one of the most gentle 
apperients. Sometimes tympanitic appearances occur. In 
such instances an injection of thin gruel, adding a teaspoon- 
full of spirit of turpentine, may be administered and repeat- 
ed if necessary. When the desired evacuations shall have 
been secured, the patient may be comforted with a dose of 
dovers powder, from five to ten grains, which may be repeat- 
ed, if the case require it. The convalesence may be guarded 
as if it had been a case of fever. 

Peritonitis is inflammation of the intestines, differing from 
the foregoing only in that the external coat and the lining of 
the abdominal cavity are involved. This coat is called the 
peritoneum, and is more sensitive than the mucous lining of 



441 

the intestines. Peritoneal inflammation is attended there- 
fore with more pain, and the vascular action is more violent, 
requiring more decisive blood-letting. In other respects the 
treatment will not materially differ in the two distinctions of 
the disease. 

When these symptoms occur in any case of fever, they 
should be met in a similar manner, modifying the practice 
according to the existing circumstances and strength of the 
patient. 

Without the aid of this important agent, it will often hap- 
pen, that the extent of blood-letting which may be necessary 
for the safety of the patient, cannot be safely carried out. 
The recovery therefore will be slow and imperfect ; and there 
will follow, weakness of the stomach, of course imperfect di- 
gestion, constipation, colic, and not unfrequently all the train 
of evils which are ascribed to dyspepsia. But the efficacy of 
the bath in maintaining the vitality of the superficial capilla- 
ries is such, that when known and understood, any ordinary 
apprehension of a failure in the system to react after the ne- 
cessary depletion, will be removed, and the attending physi- 
cian will use his lancet with becoming decision. 

If the case in the course of treatment, shall have required 
much blood-letting, it will commonly be prudent to guard 
the convalescence with a large epispatic, to be laid over the 
abdomen. 



442 DIARRHffiA. 



CHAPTER XXII. 

DIARRHCEA. 

Too frequent liquid stools, report a condition of the intes- 
tines which is called diarrhoea. The evacuations in such a 
case, are almost always offensive, light colored, watery or 
slimy, often containing some feces. It is sometimes accom- 
panied with thirst and griping pains in the belly, which seem 
to be relieved for a short time after every evacuation. It 
soon produces great prostration of strength. Some times it 
commences with fever, which is apt to be relieved by the 
evacuation itself, without medicine. It may be produced by 
excess in eating, or by eating unwholesome articles of food. 
It may depend on an irritated state of the liver, or an irrita- 
tion or inflammation of a part or the whole of the mucous 
membrane, &c. &c. It may be a mere introversion of the 
circulation, the effect of cold. 

TREATMENT. 

If attended with much pain and a tense pulse, he should 
be first bled and then bathed. If there be little or no pain, 
and the pulse be feeble or frequent, let the bath be first used 
then give ten or fifteen grains of dovers powder. If indiges- 
tible food be the known cause, a moderate dose of castor oil 
with ten, fifteen, or twenty drops of laudanum, or a gentle 
dose of epsom salts, followed by a similar portion of lauda- 
num. If there be sick stomach, or if the stools be bilious, 
accompanied with pain and straining when on the close stool. 



DIARRHffiA. 443 



give first, after the bath, a dose of calomel and opium ; say 
calomel three, four, or five grains, with one grain of opium, 
which may be repeated once or twice in twenty-four hours. 
If the disease continue, repeat the bath twice, in the course 
of the day and night ; examine the discharges, and if frag- 
ments of lumpy faeces be found mingled with the evacua- 
tions, the oil or epsom salts may be repeated, once or often- 
er as there may be occasion. 

If the disease should still recur after being apparently 
corrected, use one of the minimse pills, three or four times 
a day, and repeat the bath as there may be occasion. 

Diarrhoea is often permitted to run, till it becomes habitual, 
and when it shall have been of very long standing, it is al- 
ways more or less difficult of cure ; especially if the patient 
shall have been long accustomed to the use of tobacco, or 
have been subject to any kind of intemperance in eating or 
drinking, &c. 

Such cases would be comforted by the treatment above 
recommended. But a large majority of them will require 
much skill and patient attention. In many instances, large 
blisters made continuous, and associated with severe and ex- 
tensive friction daily repeated, will be found necessary, to- 
gether with the best known agents for recovering the tone of 
the bowels. 

Great caution in respect to diet, and a patient continuance 
in the use of suitable articles, to the exclusion of all others, 
will commonly be necessary to prevent a relapse. 



444 



DYSENTERY. 



CHAPTER XIII. 

DYSENTERY. 

There are two varieties of dysentery, acute and chronic. 
Acute dysentery begins like a common diarrhoea, with loose- 
ness and pain of the bowels : the calls to stool are frequent 
and the patient cannot help straining ; the discharges are 
sometimes large and fluid, having the common odor ; at 
other times they are scanty, often accompanied with lumpy 
matter, very slimy, streaked with blood, and very offen- 
sive. 

The patient feels more or less relief by the stool, but in 
a very short time the same pain and desire for the close 
stool returns, and there will be many repetitions of the same 
kind, in the course of twenty-four hours. For the first day 
or two, there is not much heat of skin, nor disturbance of 
the pulse ; the tongue is covered with fur, with redness at 
the tip : there is great thirst ; commonly no appetite ; con- 
siderable debility, with low spirits. After two or three 
days, a pain and soreness is felt in the lower part of the 
abdomen, and reaching from one hip to the other, which 
is greatly increased on pressure. If the patient were robust, 
the whole skin will now become hot : if feeble or delicate, 
the abdomen only will feel burning to the hand, and the 
rest of the body cool : in very dangerous cases, the extre- 
mities may be death-like cold, and the patient complain 
of being chilly. The stools become more frequent and 
scanty, being altogether mucus, or mucus mixed with blood. 



DYSENTERY. 445 



or what is worse, they may still be fluid, and of a dark 
brown color, with portions of slime afloat in it ; or they 
may be like dirty water, stained with blood, floating a few 
little lumps. After this, the stools soon become very of- 
fensive ; something like cramp is felt in the thighs and 
legs, which being relieved by each evacuation, the pa- 
tient dislikes to leave the close stool and, lie down on the 
bed. His urine seems deficient, accompanied with pain, his 
thirst is great, and his tongue dry and glazed. 

The chronic dysentery presents appearances so similar to 
Diarrhoea, that it might be mistaken for it, but for the fol- 
lowing symptoms ; which are, severe fits of griping about 
the navel, like colicj speedily followed with irresistible de- 
sire to go to stool, the discharges will be a dirty, brown, 
feculent matter, or it may be greenish, or yellowish, or it 
may look like yeast, or thin gruel, or rice water j commonly, 
however, accompanied with much wind. If not timety re- 
lieved, it progresses like a fatal diarrhoea. 



TREATMENT. 



Proceed as if it were diarrhoea. Apply the vapor bath. 
If it do not remove the pain, and especially if the pulse be 
tense, let him be bled. After the bath, whether the bleeding 
be necessary or not, administer a spoonful of castor oil with 
fifteen or twenty drops of laudanum ; or if the oil cannot be 
taken, give two or three teaspoonsfuL of epsom salts dissolv- 
ed in water, with, the same quantity of laudanum ;. or two 
or three grains of calomel, with a fourth of a grain of opium. 
Some one of these doses may be repeated every third or fourth 
hour, until a discharge of foeces is procured. In the mean 
time the patient may be comforted by large injections of 
milk and water, frequently repeated. If he be not satisfac- 



446 DYSENTERY. 



torily relieved by one course of this sort, repeat the vapor 
bath, and proceed a second time as before. If there should 
be occasion for a third repetition of a similar course of 
treatment, it would be well to apply a large blister over 
the abdomen, which, when drawn, may be dressed in 
the usual manner. The same plan of treatment will be 
proper in managing a case of chronic dysentery. 

The diet in both cases must be light, such as thin 
chicken soup, rice water, boiled milk, or boiled milk a 
little thickened with flour or rice, gradually making the 
diet somewhat more nourishing, as the patient gains strength, 
&c. 

We will conclude our remarks on dysentery by stating, 
that we have used our vapor bath in this painful affection in 
all its stages, and in every instance with the most satisfacto- 
ry effect. In a case that had become chronic, and of five or 
six weeks standing, the patient was cured by one application, 
followed by an appropriate course of diet. The treatment 
was extended to a greater than usual length of time. The 
young man sickened under the agency of the bath, and vom- 
ited as effectually as he would have done, in consequence of a 
moderate dose of ipecacuanha. The sickness was similar to 
that which follows a decisive blood-letting. 



CHOLERA MORBUS. 447 



CHAPTER XXIV. 

CHOLERA MORBUS. 

This disease generally commences with nausea and grip- 
ing, which come on suddenly, and soon terminate in vomit- 
ing and purging. In very severe cases, the body, and par- 
ticularly the extremities, soon become cold ; the breathing 
is oppressive and hurried; the features shrink; the eyes become 
hollow ; the countenance anxious ; the pulse small, contract- 
ed, and soon so weak as scarcely to be felt at the wrist ; 
thirst excessive ; the patient calling for cold water, which 
so soon as swallowed is rejected ; he complains of cramp in 
the legs, and sometimes in the arms; in some instances, 
spasmodic contractions take place in the muscles of the 
abdomen ; the discharges from the bowels are watery, with 
an offensive odor ; sometimes they appear like water in 
which meat had been soaked ; and in some instances, bi- 
lious matter is discharged upwards and downwards at the 
commencement, which changes and becomes watery. 

This alarming complaint may be produced by cold feet ; 
by suppressed perspiration from sudden exposure to cold ; 
by taking too freely of cold drinks when much heated by 
exercise ; by eating unwholesome vegetables, fruits, &c. 

TREATMENT. 

When there is good reason to suspect that some acrid 
matter in the stomach, whether vitiated bile or indigesti- 
ble food is the cause, let the patient drink a tumbler of 



448 CHOLERA MORBUS. 



warm water, having a teaspoonfull of ground mustard seed 
stirred up in it, repeating the same,if necessary, until the 
stomach is relieved. 

In the mean time, let the vapor bath be applied and con- 
tinued until free perspiration shall have been established. 
Afterwards, give a quarter of a grain of opium, with one or 
two grains of calomel every half hour, or every hour until 
the patient shall be relieved. Any inconvenience which 
may be felt after an attack of this sort, may be met and treat- 
ed according to circumstances. 

When the Asiatic cholera visited Baltimore in 1832, we at- 
tended many cases, and our plan of treatment was successful. 
The mortality in our families did not exceed five per cent. 
But those persons who were guided by our advice, regarded 
our admonition to report themselves, so soon as there was any 
occasion to apprehend an attack of the disease. 

When diarrhosa was the first symptom,, we commonly suc- 
ceeded in suspending, if not in removing it, by the use of 
the following preparation : Take opium, one grain and a 
half ; gum arabic, forty grains ; prepared chalk, forty grains : 
loaf sugar two drams : oil of cloves, two drops : grind the 
opium with the gum arabic first, then unite the other articles 
and grind them all well together, adding two drams of tinc- 
ture of kino and two ounces of water. Of this preparation 
we gave a teaspoonful every fifteen or twenty minutes, till 
the bowels were quieted. In the mean time, we used heat 
and friction externally — let blood when necessary, and in 
other respects treated it as if it had been cholera morbus or 
bilious fever, as the subsequent symptoms and circumstan- 
ces indicated. 

Excepting the peculiar kind of diarrhoea which attended 
the disease, we considered the cases of collapse, to be nearly 
assimilated to what we had been accustomed to denominate 
malignant intermittent fever. . 



colic. 449 



CHAPTER XXV. 

COLIC. 

This disease may be produced by indigestible food, cos- 
tiveness and by a diseased condition of the function of the 
liver. 

It may be known by griping pains and flatulent distension 
of the bowels, which is accompanied by a sense of twitching 
in the region of the navel ■ sometimes the muscles of the ab- 
domen appear to be drawn inward. Sometimes, but not of- 
ten, there is some degree of nausea and vomiting. Wind is 
sometimes heard rumbling backwards and forwards in the 
bowels ; the pain comes on in paroxysms, and while it is on. 
the patient is relieved by pressure, which does not happen 
when the case is inflammatory. Although the abdomen is 
hard and distended with wind, in a case of true colic, the 
pulse will remain tranquil, inconsequence of the absence of 
fever ; and when the pain is off, the countenance resumes its 
natural expression; whereas, in an inflammation of the bow- 
els, the patient inevitably looks sad, his pulse will be tense, 
and there will be a concomitant fever. 

TREATMENT. 

Administer as soon as practicable a free injection of red 
pepper tea, with the addition of an ounce or two of glaubers* 
salts ; or thin gruel with a teaspoonful or two of table salt 
and an ounce or two of epsom salts, which may be repeated 
until the bowels are evacuated. In the mean time, and with..- 
29 



450 colic. 



out waiting for the effect of the injection, apply the vapor 
bath decisively. If the case be simple colic, so soon as his 
bowels shall have been evacuated, he will be relieved. If 
there shall have been any misapprehension respecting the 
case, and it shall be inflammatory, the pains will return 
*with some signs of fever. In such an event, let him be de- 
cisively bled, and the bath be repeated. The subsequent 
treatment should be according to the instructions given in a 
case of enteritis. 

There is a very painful affection, which is commonly call- 
ed colic, the seat of which is the stomach, and which is the 
effect of indigestion. The debility of that organ, which is 
the proximate cause of the complaint, is very often the con- 
sequence of bilious fever, particularly if the patient shall 
have gone through the course of the fever, not having had 
the necessary amount of depletion. Under such circum- 
stances, the convalesence is imperfect ; a subacutely inflam- 
matory condition of the stomach remains. The function of 
digestion is impaired, and almost any kind of diet becomes 
acid. The whole mass of solid and fluid material constitut- 
ing a meal, becomes greatly offensive to the nerves of the 
stomach, producing pain till discharged by vomiting, or till 
it passes off by the action of the bowels. Supercarbonate of 
soda, in doses of thirty grains, may be taken in a gill or two 
of sweetened hot water, and repeated every fifteen minutes, 
till it produces vomiting. In the meantime use the bath. 
After the fit of colic shall pass off. the patient would be pro- 
fited by the use of the minimas pills, frequently repeating 
them, one for a dose, to be taken at bed-time. 



DYSPEPSIA. 451 



CHAPTER XXVI. 

DYSPEPSIA. 

This disease may be the consequence of indolence, intense 
study, grief, anxiety of mind, diarrhoea, abuse of alcohol- 
ic drinks, excessive use of strong tea, coffee, &c. chewing or 
smoking tobacco, and in delicate persons insufficient cloth- 
ing, or a residence in the basement story of a house or other 
damp situation, &c. &c. 

The symptoms of this disease are, impaired appetite, some- 
times a loathing of food ; in some, an excess of appetite; in 
others, the appetite is morbid or perverted. The patient feels 
an uneasiness at the pit of the stomach, most frequently after 
eating. Sometimes the sensation is, that of gnawing; at 
others, that of sinking or emptiness, or of fullness or weight. 
Some, after the food is partially digested, throw it up ; some 
feel a cramp; some are distressed with belchings; others cast 
of! the food by mouthfuls, being Continued for an hour or 
two after eating ; others are worried with a hiccough. In 
others we find flatulence, heart-bum, eructations of acrid 
■or bitter fluids. Sometimes the fluid is thin, slimy, and in- 
sipid, which is commonly called water-brash. 

TREATMENT. 

In order to effect a cure of this disease, much depends on 
diet, and it requires not little fortitude to adhere to a proper 
course, a sufficient length of time. Dyspeptic patients are 
generally more or less feeble and are said to be in delicate 



452 DYSPEPSIA. 



health. The natural secretions of the stomach are deficient 
in quantity and in their digestive qualities. The diet there- 
fore should not be fluid in quality, nor large in quantity. 
We have known the best effects from a persevering adhe- 
rence to the use of the best water cracker, with mutton chop, 
without the addition of any beverage for the space of six or 
twelve months. The medical treatment which should be 
associated with this kind of diet, may be confined to the oc- 
casional use of the anodyne alterative pill, the form of which 
will be found in the appendix. The delicacy of the pa- 
tient's health will require a strict attention to his clothing, 
which must be made to change with the various changes of 
the weather. 

Every morning, before dressing himself and every night 
before retiring to bed, as also after every instance of expo- 
sure to cold or inclement weather, so as to have been chilled, 
he should expose his naked skin to the agency of a brisk fire, 
taking his seat at such a distance as shall cause him to feel 
the heat act pungently. Then using more or less friction, 
with a brush or coarse towel, and turning from side to side 
as he will be compelled to do to endure the proper degree of 
pungency, he will set up, and at length establish a healthy 
excitement of the capillary vessels of the surface. 

By this method carefully and perse veringly continued, the 
patient will acquire a proper acquaintance with his own con- 
dition from time to time, and will learn how to correct the 
ill effects produced by vicissitudes of the weather. If, not- 
withstanding this kind of management, .he shall at any time 
take cold, let the vapor bath be applied, and it might not be 
amiss to make frequent use of this remedy. Let it be re- 
membered, that if the known cause, whatever it be, if an 
improper diet, or excess in eating, 4*c, if the use of alcoholic 
drinks, if smoking or chewing tobacco, &c. be continued, 
no remedv wiU be sufficient to effect a cure. 



JAUNDICE. 453 



CHAPTER XXVII. 

JAUNDICE. 

• This disease may be consequent on an inflammatory con- 
dition of the liver. Sometimes it occurs suddenly, when it 
is preceded by langour, some degree of restlessness, failure of 
appetite, flatulent enlargement of the abdomen, -possibly nau- 
sea, vomiting, and a dull pain or sense of weight in the re- 
gion of the liver; the tongue is generally furred and yellow; 
the urine scenty, usually of a deep yellow ; sometimes ting- 
ed with green ; and sometimes thick,' like the grounds of por- 
ter ; the bowels indolent ; the evacuations, whitish or the 
color of ashes. The color of the skin varies from that of a 
pale lemon to almost black. The change in the color of the 
skin is preceded by some tingling or itching of the whole 
body. The white of the eyes partake of the color of the 
skin, and often the patient is led to imagine, that he perceives 
a tinge of yellow or green, upon every white cloth subjected 
to his inspection. 

TREATMENT. 

Apply the vapor bath, and give him a dose consisting of 
five grains of calomel and five grains of ipecac, repeating the 
ipecac, only every half hour until he vomits. Afterwards, 
use the compound blue pill, repeating one for every third 
hour daily, often enough to keep the bowels gently free. In 
the meantime, repeat the vapor bath every night, or every 
second night, until the patient is relieved. 



454 HEAD-ACHE. 



CHAPTER XXYIII. 

HEAD-ACHE. 

Common head-ache, is less frequently the effect of disease 
m the headj than a. morbid condition of the stomach and 
bowels. In persons of a nervous temperament, it may be 
produced by exposure to cold ; and sometimes it follows ex- 
cessive depletion ; upon persons of this description long fast- 
ing has the same tendency ; in persons of plethoric habit, too 
great fullness of blood, with or without too much exercise, 
can produce head-ache. » 

When pains in the head are preceded by chilly sensations, 
and attended by giddiness and drowsiness, and especially if 
produced by very slight exertion ; or if set up by entering 
a heated apartment, or by taking a moderate stimulant, 
ought never to be permitted to exist long without medical 
aid. 

TREATMENT. 

A slight nervous head-ache is often relieved by bathing 
the feet in very hot water, or toasting them naked, severely, 
at the fire, and drinking a cup of hot tea. 

A sympathetic head-ache, such as depends on the condi- 
tion of the stomach and bowels, is as certainly relieved by a 
gentle emetic, followed by a suitable apperient for the 
bowels. 

When it has been produced by exposure to cold, bathing 
the feet in hot water, &c. and holding a shovel of burning 



HEAD-ACHE. 455 



coals, so as to act intensely upon the head and face will com- 
monly afford relief. If these measures should fail, however, 
apply the vapor bath ; if all fail, it may safely be concluded 
that blood-letting is necessary. 

The last description of head-ache, defined as above, al- 
ways implies a tendency to fever, and should be treated by 
blood-letting, and the application of the vapor bath ; both of 
which may be repeated, once or oftener, until the patient is 
relieved; commonly, however, in a case of this sort, a ca- 
thartic, and possibly a repetition of it may be necessary. 

Thus far, we have had in view such cases of head-ache as 
occur incidentally, and pass away in due time, without any 
serious consequences. All such cases must be considered as 
materially different from the kind of pain in the head, which 
ushers in and accompanies cases of fever. Very often the 
amount of danger which is to be apprehended in the com- 
mencement of an autumnal attack of idiopathic fever, may 
be estimated by the degree of head-ache which attends it. 
In such a case no temporising is admissible. If the pain be 
very severe, and the pulse be tense, the life of the patient 
may depend on a speedy and decisive blood-letting ; and if 
it should not be relieved by one bleeding, it may be neces- 
sary to repeat the operation once or oftener. 

If the first exacerbation of a bilious fever in autumn, or of 
a pleurisy, or other inflammatory disease in winter or spring, 
or summer, should be permitted to wear itself down, without 
depletion, and a settled pain in the head be the consequence, 
not only a single blood-letting may be necessary, but fre- 
quent repetitions of the same, cupping, leeching and blisters 
might be necessary to save the life of the patient. 



456 piles. 



CHAPTER XXIX. 

PILES, OR HEMORRHOIDS. 

Persons who are afflicted with piles, suffer only occasion- 
ally ; when they are commonly said to have an attack of 
piles. A sense of heat and fullness is felt in the rectum, at- 
tended sometimes with a stinging pain, which is increased 
when at stool. The straining which it produces, is often 
attended by a considerable discharge of blood ; and the sen- 
sations felt, are very much like those that attend a case of 
dysentery. Persons in this condition are often said to have 
blind or bleeding piles. But the disease is sometimes exter- 
nal, when the tumors swell enormously. In this form there 
is more or less of a constant discharge, and that rather in 
small quantity. Sometimes the hoemorrhage is copious, af- 
fording temporary relief from pain. If the disease be very 
inflammatory, the tumors may remain swollen for a consid- 
erable time, and become indurated and be followed by great 
inconvenience. 

The disease is often produced by the straining that attends 
a costive disposition. Costiveness is ordinarily the conse- 
quence of deficient functional action of the liver, and the oth- 
er glands associated with that organ. A sluggishness of the 
liver, will inevitably be attended by a fullness and languid 
action of the vena porta, and its branches. The mucous lin- 
ing of the rectum must partake of this fullness, it follows 
therefore, that the piles are consequent upon this catenation 
of errors. 



piles, 457 



TREATMENT. 



Let the liver be excited by small doses of calomel and ipe- 
cacuanha, say one fourth of a grain of each, repeated once, 
or twice, or thrice a day. When the necessity of a stool is 
beginning to be felt, inject half a pint or pint of a tea of flax- 
seed or slippery elm. Under no circumstances let aloes be 
used in any form. Whenever a fit of piles is perceived to 
be coming on, in addition to the frequent employment of 
calomel and ipecac, and the regular use of the injections, let 
the patient be treated with a decisive vapor bath. 

When the disease is external, the general treatment may 
be as before directed* If at any time, however, the inflam- 
mation and pain be considerable, the case requires blood- 
letting from the arm, and scarifications, or the application of 
leeches as a topical remedy for the tumors. After which 
give him the benefit of a decisive vapor bath, to be followed 
by ten or fifteen grains of dovers powder, adding two or three 
grains of calomel to each dose, and repeating the same every 
hour until he is at ease. A case may occur, however, in 
which the inflammatory condition may be such as to require 
one, two or more repetitions of the same remedies. 



458 RHEUMATISM. 



CHAPTER XXX. 

RHEUMATISM. 

Rheumatism is commonly considered under two distinc- 
tions — acute and chronic. The patient complains of pain 
about the joints and following the directions of the muscles ; 
commonly attacking the knees and larger joints, in preference 
to those of the feet and hands ; accompanied by considerable 
fever. Sometimes, however, the hands and feet, fingers and 
toes are all affected with pain, heat, and considerable 
swelling. 

Acute rheumatism commonly attacks young people : or, to 
be more definite, people below the middle age. It is often 
set up by long exposure to cold and wet weather; by sleep- 
ing in damp sheets ; by remaining long in wet clothes, par- 
ticularly after . fatigue ; or by laying off winter clothing too 
early in the spring. 

In acute rheumatism the patient at first complains of chill- 
iness, with an uncomfortable feeling of numbness, pain or 
aching. Symptoms of fever soon follow, when the skin be- 
comes pungently hot, and the pulse quick, full and tense and 
bounding. The repetitions of the strokes may vary, from one 
hundred to one hundred and sixty in a minute. As the 
symptoms of fever increase, the pain becomes more acute. 
The sensation is 'that of an aching or gnawing pain, with 
numbness and inability to move. Sometimes the symptoms 
are pungent, hot, and lancinating as those of the gout. The 
patient sometimes complains of pain and soreness over the 



RHEUMATISM. 459 



whole body; but more particularly, of some one joint. 
Sometimes the distress seems to fasten upon one limb ; then 
lets go its hold and seizes another. * The affected parts usu- 
ally become red, swollen «and tender to the touch; at other 
times, these appearances are slight in comparison to the de- 
gree of pain. As in gout, the least motion aggravates the 
distress which shoots along the course of the muscles, or the 
nerves and their branches. The pain and feverish symp- 
toms, abate and increase, without regard to regularity, how- 
ever, except that like almost all other diseases, the patient is 
most tormented at night. It may affect the intercostal mus- 
cles, when physicians term it pleurodynia, which is sometimes 
mistaken for pleurisy. The rheumatic condition may affect 
the muscles of the abdomen, then it in some sort resembles 
peritonitis. The muscles of the back are often affected, 
when it is called lumbago ; in some instances, the sciatic 
nerve or the muscles which pass from the trunk to the lower 
extremities, are affected, this is called sciatica. These last, 
apparently local affections, frequently occur without fever,, 
unless during the night, and have been commonly considered, 
instances of chronic rheumatism. 

In acute rheumatism the tongue is commonly furred, often 
red, particularly round the edges, and fissured ; there is loss 
of appetite, great thirst, scanty and high colored urine, de- 
positing a heavy sediment. Sometimes there are nausea 
and vomiting ; *much internal heat, particularly in the region 
of the stomach ; the bowels are generally costive, emitting 
an offensive odor. In some instances, there is headache with 
intolerance of light, and in some, inflammation of the eyes ; 
in some instances, irritation and inflammation of the brain 
takes place ; but of all parts, the sack containing the heart is 
most liable to become inflamed, daring the course of a rheu- 
matic affection. The skin is generally dry and hot, though 
sometimes it is attended with a profuse clammy sweat. 



460 RHEUMATISM. 



TREATMENT. 

The first and most important remedy is blood-letting to an 
extent sufficient to subdue the tensjon of the artery. This 
should be followed by frequent small doses of tartarized an- 
timony, so as to keep up slight nauseau without producing 
vomiting. Iu the evening apply the vapor bath, and con- 
tinue the antimony through the night, remembering, how- 
ever, not to disturb the patient when asleep. If the fever 
should rise about midnight, accompanied with a considerable 
increase of the pain and a tense pulse, let him be bled again, 
until the tension of the pulse is corrected ; the day following, 
continue the antimony as before, and if the pains increase at 
midday, and the pulse again become tense, blood-letting 
may be again repeated as before, until the tension of the 
pulse retires. After the third bleeding, sometimes after the 
second, and in a few instances even after the first, general 
blood-letting ceases to be useful. The vapor bath, however, 
maybe profitably employed every evening and morning ; and 
when general blood-letting is no longer useful, cupping or 
leeching, often affords important relief to the affected joints. 
If the pain move from one place to another, it will be proper 
to chase it, from point to point, until it takes its departure. 
In the meantime, the other modes of treatment are to be 
continued. In some obstinate cases the vinous tincture of 
colchicum, in doses of half a drachm to two drachms, may 
be repeated twice a day with advantage. In addition to the 
colchicum, fifteen or twenty grains of dovers powder, or two 
or three grains of the extract of hyosciamus, or what perhaps 
would be far more agreeable, ten or fiften or twenty drops of 
Dr. McMunn's elixir of opium, at bed-time. After the vio- 
lence of the symptoms have been somewhat subdued, it will 
be necessary to have recourse to blisters, and treat the case 
as one of retiring fever.. 



CHRONIC RHEUMATISM AND GOUT. 461 



CHAPTER XXXI. 

CHRONIC RHEUMATISM AND GOUT. 

The chronic form of rheumatism sometimes succeeds the 
acute. It may be confined to one part part of the body, or it 
may be general. It is attended with a dull gnawing pain, 
which is increased on motion ; with little or no fever or local 
inflammation. The joints sometimes swell and occasionally 
contract, and the muscles sometimes become rigid. 

TREATMENT. 

The vapor bath may be applied generally and topically;; 
and repeated daily, once or oftener, as there may be occasion, 
to which may be added the use of antimony, when the case is 
feverish; and the colchicum and anodyne at night, as ad- 
vised under the head of acute rheumatism. In either acute 
or chronic rheumatism, severe purging is injurious, yet the 
bowels must be kept in a good condition. 

Gout is so nearly assimilated to rheumatism, it may be 
considered under the same chapter. There are marks of 
difference, however. Gout rarely attacks the young. Males 
are more liable to it, than females. It is more connected 
with internal disease than rheumatism ; more particularly, 
with affections of the viscera involved in indigestion. It 
generally infests the smaller joints ; rheumatism the larger. 
In gout, the pain is burning, pungent, and lancinating. In 
rheumatism it is gnawing and numbing, though sometimes 
it is also pungent and lancinating. In gout the external in- 
flammation is more bright and intensely red. The swelling 
takes place more rapidly and the parts affected are more sen- 
sible and tender. Treat the case like rheumatism. 



462 HffiMOPTHYSIS. 



CHAPTER XXXII. 

HGEMOPTHYSIS. 

"The name of this disease, signifies a discharge of blood 
from the air passages. It occurs chiefly under three forms. 
The first variety is the effect of a general exhalation from 
the mucous surface of the bronchi or air tubes. This variety 
is most common, and generally is not dangerous- It attacks 
women at their monthly periods, when the menstrual dis- 
charge is too scanty or is entirely suppressed. It sometimes 
befalls men, upon the sudden drying up of an old sore, &c. 
It is commonly preceded by some symptoms of fever ; the 
bowels are out of order ; tongue foul ; the patient has restless 
nights, and feels most comfortable sitting half erect in the 
bed. At length there is cough, which is often constant and 
distressing with more or less difficulty of breathing. The 
pulse generally is quick and irritated. The affection often 
comes on insidiously; but the bloody expectoration com- 
monly comes on with a cough. The material thrown up has 
an appearance like red currant jelly: sometimes the discharge 
is copious but generally it is moderate ; at others it is of a 
mixed kind, small masses of blood mixed with mucus. Oc- 
casionally it is quite bloody, moderate in quantity and frothy. 
Again in some cases pure blood in large quantities, is dis- 
charged. Whatever its appearance, it is increased b} 7 " exer- 
tion, whether of body or voice. 

TREATMENT OF THIS FIRST VARIETY. 

If the patient be plethoric, or if there be considerable fever 
and a tense pulse, one blood-letting is commonly necessary : 



HffiMOPTHYSIS. «463 



perfect rest, silence, abstinence from all stimulants, allowing 
a very small quantity of food at a time. The bowels should 
be kept in pretty brisk action, by the use of mild laxatives 
frequently repeated. If the bleeding still continue, with a 
pulse expressive of fever, excite some degree of nausea by 
small doses of tartarized antimony; or the stomach might be 
made to feel nausea, by the use of table salt. hi. some in- 
stances much might be accomplished by a single application 
of the vapor bath. After which, if necessary, give two, three 
or four grains of the acetate of lead, every third or fourth 
hour. In some instances, ten or twenty drops of the spirits 
of turpentine, in a spoonful or two of sweet milk, adding a 
little sugar and repeated every twenty or thirty minutes, has 
been found very effectual. In some instances, the muriated 
tincture of iron, in dose^ varying from fifteen to twenty-five 
or thirty drops, in a little cold water, and repeated every two 
or three hours, has been found to have a very happy effect. 

A SECOND VARIETY OF HCEMOPTHYSIS. 

The second variety commences with chilliness, cold ex- 
tremities, followed by flushes of heat and redness of the 
cheeks, headache, frequent and tense pulse, palpitation of 
the heart, and a sense of weight at the pit of the stomach. 
The bloody discharge from the lungs, is attended with diffi- 
culty of breathing, with a sense of smothering, accompanied 
with pain. A sense of rawness, is felt in the throat, and a 
saltish taste in the mouth. The expectoration is a bright 
and frothy red or black and clotted blood, which is some- 
times mixed with saliva or a little mucus. The pulse is fre- 
quent and full, though somewhat irregular ; no considerable 
heat of skin, and sometimes profuse perspiration. The spit- 
ting of blood is copious ; returning by fits, and accompanied 
by a convulsive motion, which has led to the expression of 
vomiting blood and sometimes indeed a portion may come 
from the stomach. The appearance of the countenance va- 



464 • HCEM0PTHYS1S. 



ries, sometimes exhibiting intense redness, and at other times 
extreme paleness. 

TREATMENT. 

The most important point of difference, to be regarded in 
the treatment of this modification of hoemopthysis, is that 
the first bleeding, ought to be very decisive, so as to induce 
fainting. In other respects, the management may be nearly 
the same. In this distinction, however, the loss of blood by 
the hoemorrhage and by the use of the lancet, is so great, 
that special attention must be paid to the condition of the 
capillaries of the external surface. By the agency of the va- 
por bath, aided by friction and epispastics, the convalescence 
must be guarded. If too much paleness of the surface and 
concomitant stricture of the capillaries be permitted to re- 
main, permanent congestions will be set up in the lungs, if 
an early return of the haemorrhage, should fail to carry off 
the patient. 

The third distinction referred to, in the preceding remarks, 
occurs in cases of consumption, of which it is not our inten- 
tion to say any thing in this work. 

Persons not having witnessed the effect of the vapor bath 
might be apprehensive that the application of heat would 
increase hoemorrhage from the lungs. For the removal of 
that difficulty, we have to state, that blood taken from the 
arm of a patient whilst under the influeuce of the bath, or 
immediately after, will coagulate in much less time than is 
required to produce that change under ordinary circumstan- 
ces. Moreover it is much more florid in its appearance. We 
have not witnessed any injury done by the bath in any case 
if blood-letting preceded its application. Common sense will 
forbid the use of any excitant when a large vessel shall have 
been ruptured. Any such case, of course, is excepted 



INFLAMMATION OF THE EYE. 46& 



CHAPTER XXXIII. 

INFLAMMATION OF THE EYE. 

The symptoms of inflammation of the eye may be divided 
into local and constitutional. The local symptoms are first a 
sensation, such as may be produced by a grain of sand in the 
eye : this is followed by a sense of heat and pain in the eye- 
ball ; increased secretion of tears ; intolerance of light, and a 
feeling as if the eyeball were swollen. If the inflammation 
be in the external coat of the eye, the eyelids often become 
swollen, which is not an unfavorable symptom. This kind 
of inflammation, may be produced by the introduction within 
the eyelid, of sand, dust, lime, small insects, by tumors grow- 
ing within the eyelids, and by the inversion of the eyelashes. 
It may also be produced by exposing the eye too long to the 
direct rays of the sun, or by looking too long into a tewel of 
a forge or furnace. 

Among the constitutional causes, are a plethoric and fever- 
ish condition of the system, a disordered state of the bowels : 
as also a sudden healing of an old ulcer and the like. It may 
be produced, by a cessation of the constitutional discharges, 
peculiar to the fair sex ; in children, by dentition ; by a general 
chronic disease of the mucous membranes, by acute and 
chronic diseases of the skin* and in adults it may be the re- 
sult of a misplaced gout or rheumatism. Some of the most 
severe and unmanageable diseases of the eye, follow small 
pox,, scarlet fever, and measles. It might be proper to add 
here, that diseases of the eye may be produced by acrid va- 
pors; by residing in damp and exposed situations; or by par- 
ticles of dust unavoidably produced by the man's occupation . 
30- 



466 INFLAMMATION OF THE EYE. 

TREATMENT. 

Known local causes must be removed ; suspected causes 
must be sought after by careful inspection, and it is often 
necessary in making search, completely to avert the upper 
eyelid. If lime or any irritating agent of that sort shall have 
been the cause, let fall two or three drops of warm fresh hog's 
lard into it, which may be repeated, as often the case shall 
require. Many slight cases will be relieved by washing in 
warm water. And when the irritation is protracted, apply over 
the closed eyelid soft cloths of suitable size dipped in water 
made mucilaginous by steeping in it, small bruised twigs of 
the sassafras tree or the shavings of slippery elm bark, first 
straining the mucilage, and repeat as it affords comfort. When 
these simple and mild remedies fail to afford the necessary 
relief, especially if the eye cannot bear a moderate light ; or 
if pains dart through the head ; and in all cases if there be 
fever with a tense pulse, a very decisive blood-letting is ne- 
cessary. After the bleeding, the same day or evening a com- 
plete application of the vapor bath. The following day, a 
brisk cathartic ought to be administered. If the fever and pain 
return with any degree of severity, repeat the bleeding and 
the vapor bath ; but if the symptoms be much more mode- 
rate on their return, use the vapor bath only, which some- 
times will require to be sustained by the use of blisters, &c, 
managing the case, as 'if it were an instance of fever. If 
after all, the disease should be protracted, the case may be 
considered constitutional, and a minima pill may be given 
three or four times in twenty-four hours, aiding it if neces- 
sary, with some gentle aperient, to maintain a free state of the 
bowels ; as small doses of epsom salts, or the milk of sulphur 
and cream of tartar mixed in equal quantities. 

If the eye remain weak, after an inflammatory attack shall 
have been corrected, some of the eye-water recommended in 
the appendix may be used. 



HYDROCEPHALUS. 467 



CHAPTER XXXIV. 

HYDROCEPHALUS, OR DROPSY OF THE BRAIN. 

This disease is ordinarily considered under two general 
distinctions — acute and chronic. Under the acute form, we 
shall notice four principal varieties. The first is attended 
with severe symptoms : such as fits of screaming ; grinding 
the teeth ; hot skin ; frequent pulse ; the countenance wild 
and staring ; red face and eyes ; these are often followed by 
convulsions ; or the patient may become lethargic ; children 
affected with this variety of the disease, die on the third or 
fourth day. 

The second variety presents symptoms very mild and in- 
sidious, very often remaining unnoticed for several days. 
The child is known to complain, but it is thought to be pee- 
vish or teething, and too often nothing but the long continu- 
ance of indisposition and the emaciation of the little patient, 
give the alarm, when perhaps it is too late. 

A third variety commences with irritation of the stomach, 
the bowels meanwhile, being confined or too loose. The 
child seems to have no fever through the day, but the febrile 
symptoms are very obvious at night. The physician and the 
parents are often deceived, considering it merely an affection 
of the bowels. After a while, the child will be quiet while 
lying in the cradle or on the bed, except that it grinds its 
teeth occasionally. It shows some signs of suffering, but 
neither cries nor frets, unless when raised up, but the moment 
the head is elevated it is greatly impatient and makes, loud 
expressions of pain, probably because it feels headache or 
giddiness. 



468 HYDROCEPHALUS. 



Another variety is that which occurs during the course of 
other diseases ; such as fevers, measles, hooping cough, vio- 
lent catarrh, bronchitis. &c. Too often when thus seconda- 
rily produced, it progresses into a condition' past recovery,, 
before it is observed. Convulsions perhaps give the first 
alarm ; though sometimes, a comatose state, will give the 
first notice of the existing state of things. 

TREATMENT. 

Case^s of the first variety, require decisive blood-letting, 
without delay, which in violent cases, ought to be followed 
up in the course of three or four hours by the application of 
leeches, but the leech bites ought not to be permitted to 
bleed after the necessary quantity is taken. Afterwards 
small doses of tartarized antimony, say one grain dissolved in 
twenty or thirty teaspoonsful of cold water, of which one 
teaspoonful is the dose, to be repeated every second hour, 
until the bowels shall have been sufficiently evacuated. If 
however the antimony fails to act on the bowels, give the 
fourth of a,grain of calomel, in addition to each of its doses. 
In the meantime, cold applications maybe made to the head, 
and it should be subjected to the action of the vapor bath. 
Great advantage has sometimes been gained by the use of an 
ointment of tartarized antimony, so as to produce a pustular 
eruption on the head. 

As to the second variety, it ought to be suspected in every 
instance, where mild remedies do not afford relief. Infant 
children, are incapable of affectation, and peevishness is 
therefore an evidence of sickness. If teething be suspected. 
that difficulty may be removed at once, by a careful exam- 
ination, and if necessary, scarifying the gums. This done, 
if the child continue to complain, let hydrocephalus be feared, 
and let measures be taken in imitation of those prescribed 
raider the first variety, and be carried out as decisively as the 



HYDROCEPHALUS. 469 



strength and temperament of the patient will justify. The 
same kind of vigilant caution with intention to avoid dan- 
gerous delay, should be taken in respect of patients when 
seized with vomiting, &c. as specified under the third varia- 
tion, and a practice similar to that recommended under the 
second variation should also be employed under this. 

When symptoms indicative of dropsy of the head occur 
during the course of other diseases, the same vigilance with 
measures suited to the condition of the patient will in like 
manner be proper. . > 

In any case of this sort, under whichever of the varieties, 
when a determination of the circulation to the head shall 
have been set up, a paleness of the skin, which signifies a 
failure in the circulation of the superficial capillaries, on care- 
ful inspection may be seen showing the necessity of associa- 
ting constant irritation of the surface, with the blood-letting 
or other evacuating means that may be employed. In any 
of the varieties in which this disease may be seen to make its 
approaches, we have seen the best effects to follow appropri- 
ate doses of calomel and ipecac, so apportioned as to produce 
pretty decisive purging. 



470 DYSMENORRHEA. 



CHAPTER XXXV. 

DYSMENORRHEA, OR PAINFUL AND DIFFICULT MEN- 
STRUATION. 

In dysmenorrhea, the disaharge is generally scanty. It is 
sometimes in natural quantity ; sometimes it passes away in 
stringy shreds ; in others a small organized mass, or lump, 
commonly called a false conception, or a mole. 

A few days before the expected time, the patient com- 
plains of pain in the back, loins, and hips, and perhaps there 
is an appearance of some show. If the patient be required 
to give a particular account of herself, she will complain of 
weakness, weariness, a sense of weight or tightness, severe 
cramp or spasm, colic, bearing down, resembling the pains 
of labor, particularly when passing shreds, and still more so 
when the lump or mass is expelled. Her abdomen becomes 
swollen, sometimes tense, wind is heard moving about in the 
abdomen ; her appetite is impaired ; her bowels constipated : 
her stomach often irritable ; sometimes affected with vomiting ; 
and the urine is sometimes suppressed. Some women suffer 
pain for only one day, and others for the whole period. 

TREATMENT. 

When the painful condition occurs, let the patient be bled 
according to her strength and ability to bear it ; then let her 
retire to bed and receive an application of the vapor bath : 
taking every two hours a cup of tea made of the herb hydro- 
piper,* in the strength of one dram of the dried leaf to a pint 
of boiling water. 
# Common smart weed. 



MENORRHAGIA, 471 



CHAPTER XXXVI. 

MENORRHAGIA, OR IMMODERATE FLOW OP THE MENSES. 

When the discharge is more than habitual,*or when it pro- 
duces weakness or other unpleasant symptoms, it may be 
considered a disease. It is secondary, however, and is con- 
sequent upon some previous impairment of the patient's 
health. 

For the general treatment, therefore, the constitutional er- 
ror must be detected, and corrected. In a majority of instan- 
ces, the liver and vense portse are in fault, and may be cor- 
rected by the use of the minima? pills, one to be given in the 
morning, one in the afternoon, and one at bed time, for five 
or six days. Then one, morning and evening for as many 
more days ; after which one every night only, until the pe- 
riodical time returns. 

To arrest the profuse discharge when it recurs, let the pa- 
tient retire to bed, and be treated decisively by the vapor 
bath, which may be followed by a dose of fifteen or twenty 
grains of do vers powder. 

In a case of this sort, paifts must be taken to improve the 
health and strength of the patient,, by the use of good wine, 
frictions repeated night and morning ; passive exercise, such 
as riding in a carriage, &c. and in many instances the tinc- 
ture of cantharides, in doses from ten to twenty drops, re- 
peated three or four times a day, with or without the addi- 
tion of from five to ten drops of the muriated tincture of 
iron. 

Sometimes also, we have found very great benefit result 



472 MONORRHAGIA. 



from the use of the prussiate of iron, in doses of ten to fifteen 
grains, given in a little new milk or cold water, and repeated 
three or four times a day, or oftener if necessary. In each 
instance of its recurrence, let the same course be pursued, 
according to circumstances. The inconvenience here treat- 
ed of, is often produced by a malposition of the uterus. In 
every such instance, before a cure can be effected, the organ 
must be restored to its place by skillful manipulation. 

An essay will be found in the appendix giving useful in- 
struction in respect of a misplaced uterus, which will claim 
attention when necessary. There are many instances of the 
inconvenience, of which this chapter treats, the effect of im- 
prudence. Young ladies of very delicate constitution may 
be the subjects of it, in consequence of tight lacing. The 
exchange of a corset for a bandage as tight or tighter, does 
not lessen the injury. The compression imposed upon the 
blood-making organs, by either of these pernicious fashions 
is nearly the same. Tight lacing therefore must be discon- 
continued. 

Anxiety of mind may be greatly injurious. If it exist, let 
the cause of it also be removed. These done, medication 
may be effectual. 



CESSATION OF THE MENSES. 473 



CHAPTER XXXVII. 

CESSATION OF THE MENSES. 

When women arrive at that age, which by them is com- 
moniy called the turn of life, the periodical discharge becomes 
irregular, sometimes obstructed for a season and then returns 
again. 

Symptoms often occur, such as are significant of pregnan- 
cy, and in some instances there is considerable uterine pain, 
with a dragging sensation in the back and groins; more or 
less fever; head-ache, with a full strong pulse; irregular 
state of the bowels; furred tongue; imperfect digestion ; and 
sometimes active hoemorrage from the womb. 

These appearances often give alarm, and lead to the em- 
ployment of quackeries, which seldom are useful, and often 
very mischievous. Many women suffer no particular incon- 
venience at this period, some have better health than before, 
especially such as have suffered from dysmenorrhea. 

TREATMENT. 

When the symptoms are slight, nothing more is necessary 
than a proper attention to diet, and to the state of the bowels; 
to keep on warm clothing and to use proper exercise. 

Should any particular organ be threatened with inflamma- 
tion, as the head, the lungs, the stomach, the liver or bowels, 
the treatment should be addressed to the organ that may be 
threatened, as in any other instance of inflammatory disease. 
In such an event, one blood-letting at least is commonly ne- 
cessary. Afterwards a repetition or two of the bath, and at- 
tention to the state of the bowels will be sufficient. 



474 CHRONIC HYDROCEPHALUS. 



CHAPTER XXXVIII. 

CHRONIC HYDROCEPHALUS. 

This variety of the disease frequently follows the acute 
form, from neglect or mismanagement ; the one form having 
run into the other ; but ordinarily it is insidious in its ap- 
proaches, and progresses slowly. Possibly a stranger may 
take the first notice of the enlargement of the child's head ; 
which may continue to be the most prominent symptom. 

TREATMENT. 

The symptoms are to be met as they arise. If signs of 
fever, with or without pain, recourse rnay be had to the use 
of leeches, frequent blisters, or counter irritation, by the oint- 
ment of tartar emetic, attention to the bowels by the agency 
of calomel and ipecac, regulating the diet, &c. 

In any, and in all cases of affections of the head, if the 
state of the skin indicate the necessity of the vapor bath 
the patient's head should be kept cool during its adminis- 
tration. 



AMENORRHCEA. 475 



CHAPTER XXXIX. 

AMENORRHEA. 

If the menses do not begin to flow at the age when nature 
requires it, the patient becomes restless, peevish, and feels 
incapable of executing her task, or taking her place in the 
performance of her share of domestic duties. She complains 
of weariness, langour, and debility. Her flesh wastes away, 
her countenance becomes pale, and her skin sallow. She 
loses her appetite, and desires to eat chalk, common earth, 
and lime, if she dare, &c. Her feet and ankles swell, her 
abdomen is enlarged with flatulence, particularly after meals 
and towards evening. Her urine is scanty or copious, her 
bowels torpid, and feet and hands cold. Some feel great 
anxiety about their condition, others indicate the greatest 
listlessness in regard of every thing. Ultimately a cough 
and hurried respiration, together with expectoration. Her 
bowels, which were at first torpid, become irritable, and are 
affected with incessant diarrhoea. Hectic fever follows, and 
the patient dies greatly emaciated, with or without the ap- 
pearance of consumption. 

Sometimes however, the symptoms take a different course, 
and the patient is seized at once with symptoms of consump- 
tion. 

TREATMENT. 

If the patient be in robust and plethoric habit, at the peri- 
odical time, which may generally be known by the recur- 



476 AMENORRHEA. 



ence of pain, &c. let her be bled, which may be repeated 
at one, two, or three consecutive monthly periods. After 
the bleeding, let her take three compound- blue mass pills 
every third hour, till they operate ; after which, having first 
bathed her feet in very hot water, let her retire to bed and 
be treated by the vapor bath. 

If this practice, after having been two or three times re- 
peated, should produce the desired effect; during the suc- 
ceeding interval of time, let the patient take ten drops of the 
saturated tincture of cantharides, three times a day, gradu- 
ally increasing the quantity to thirty or forty or even sixty 
drops. It must be remembered, however, that this remedy 
must be suspended if it produce any irritation in the bladder 
or urethra, when the patient may be comforted by taking 
small doses of camphor and flaxseed tea, or a mucilage made 
with the twigs of sassafras or slippery elm bark. 

If this treatment should fail altogether to give relief, the 
physician should examine and know if any malformation, or 
want of perforation of the hymen, or of the os tineas, may be 
the cause of delay. 

Any case of a suppression of the menses, whether it be 
the effect of cold or other accidental cause, will commonly 
be relieved by similar treatment. 



PUERPERAL FEVER. 477 



CHAPTER XL. 

PUERPERAL, OR CHILD-BED ^EVER. 

As in other forms of fever, so in this, there are two varie- 
ties; the one is marked with symptoms almost exclusively 
inflammatory, and seems to be the result of a strong vascu- 
lar action, in which the arteries are chiefly concerned. 
Which variety is marked with conspicuous violence, and re- 
quires a speedy and decisive treatment. The other variety 
is more insidious being more or less dependent for its origin, 
on venous congestion. Both of these varieties are accompa- 
nied by symptoms of peritoneal inflammation. 

The variety which is most directly inflammatory, may be 
produced by violence during delivery; or by the injudicious 
use of stimulants, when at the same time, an irritable condi- 
tion of things is present, requiring a copious blood-letting. 
In either of these instances, the symptoms of puerperal fever 
may occur within twenty-four hours after delivery ; though 
sometimes not until the expiration of a few days. When 
venous congestion is concerned in the production of puerpe- 
ral fever, we have for years believed that the predisposing 
cause, if traced to its origin, would be found to have been, 
neglected constipation, by which accumulated scybala on 
the one side of the wall of the intestine, presses it so hard- 
ly against some soljd part of the foetus as to weaken its struc- 
ture, or the head or nates on the one side, and the hip of the 
mother by the weight of the foetus press the uterus or a por^ 
tion of the intestine, so as to produce a similar effect on one 
of those organs. The pressure being removed by the birth 
of the child, the enfeebled capillaries are injected to a state 



478 » PUERPERAL FEVER. 



of congestion, which, if considerable, must sooner or later 
set up irritation and consequent inflammation. 

By whatever cause puerperal fever shall have been induced, 
the symptoms are, rigors, shiverings, with thirst, fever, hur- 
ried and tense pulse, sickness and vomiting. These are 
soon followed by pain, tension or soreness, either over the 
whole abdomen, or it may seem to be confined to one spot. 
These increase rapidly, and the belly in a short time, be- 
comes greatly swelled, exquisitely tender so that the weight 
of the bed-clothes can scarcely be endured, and the least mo- 
tion gives great distress to the patient. The skin is hot, the 
tongue white and dry,- and the milk and the lochia are usu- 
ally suspended. The bowels are either costive or there is a 
purging of dark colored foeces ; and sometimes an incessant 
inclination to urinate. As the disease advances, the symp- 
toms of inflammation and irritation, increase ; difficulty of 
breathing ; the pulse small and frequent, beating from one 
hundred to one hundred and thirty strokes in a minute. The 
swelling and tension of the belly, increase ; the vomiting 
continues ; the pulse becomes smaller, more frequent and ir- 
regular ; the extremities cold ; the evacuations by urine and 
stool become involuntary: the pains cease and the patient 
dies, about the sixth or eighth day, of her disease. 

As in other forms of fever, so also in that of child-bed, the 
condition of things may correspond to that which is called 
congestive, and find a fatal termination in the same speedy 
manner. 

There is a goodly number of physicians of high reputation, 
who are of opinion, that child-bed fever maybe contagious. 
We have never met with any case, which in our estimation, 
could support that opinion. We believe with Colombat and 
others, that hospitals devoted to lying-in women may furnish 
appearances, which might lead to the conclusion, that the 
disease may become epidemic. Such supposed epidemics 
have occurred at Paris and other hospitals in France : at Ab- 



PUERPERAL EEVER. 479 



«rdeen in Scotland, and at Leeds and Sunderland in England, 
and in various parte of the United States. In our estimation, 
however, this is unimportant, and would prove nothing but 
•a want of proper management in those institutions. 

/ TREATMENT. 

Inasmuch as lying-in women are so liable to an attack of 
this formidable disease, it is of the utmost importance, that 
the best prophylactic means should be used, in all cases. 
Pending the time of gestation a costive habit should be 
guarded against and corrected if it occur. A prudently se- 
lected diet, with an occasional dose of castor oil when neces- 
sary, or of epsom salts with manna, if it be preferred, or of 
calcined magnesia, &c, may answer all purposes in this re- 
spect. 

If at any time a fixed pain should be felt in either hip or 
the back, and especially if it be more comfortable to lay on 
the side affected by the pain ; the patient should invariably 
compel herself to lie on the opposite side, if the pain be in 
the hip, and inclining over towards the face if in the back. 

Under all circumstances a feverish condition at any time 
during pregnancy, should be corrected, and if necessary by 
blood-letting. If in time of parturition the woman be seized 
with pain in the head, or fever to any considerable amount, 
a decisive blood-letting will be necessary to her safety. 

If she be much exhausted by the efforts of the labor or by 
its protraction, or by considerable hemorrhage, let her be sub- 
jected to the action of the vapor bath, which may be followed 
by a dose of fifteen or twenty grains of dovers powder, with or 
without the addition of five or ten grains of calomel, to be 
followed six hours after, by a dose of castor oil, &c. 

Whether these preventive measures shall have been used 
or not, and the rigors, chilliness, thirst, &c. that usher in 
child-bed fever shall occur, it must be met by very decisive 
treatment. 



, 480 PUERPERAL FEVER. 



If the case be inflammatory, corresponding to the descrip- 
tion given above, blood-letting to an extent necessary to sub- 
due the tension of the pulse j and if after one bleeding the 
pulse becomes slower and fuller, and the pain subsides ; a 
return of the pain will indicate the necessity of a repetition 
of the blood-letting ; which should be followed by a com- 
plete evacuation of the bowels with some gentle cathartic. 
A recurrence of similar circumstances will indicate the pro- 
priety of a third repetition of the same practice. In the mean 
time it will be found useful to employ the vapor bath after 
every blood-letting. Afterwards the case may be treated in 
the manner which would be proper in a case of any mild 
fever. 

If however, after the first decisive blood-letting the pulse 
shall remain frequent, and other symptoms not be materially 
improved, the inference may be safely drawn, that a condi- 
tion of things, such as sets up and maintains permanent irri- 
tation exists in the case. Let the vapor bath be applied with 
decision, and be followed by a dose of dovers powder, say 
five grains, with one grain of calomel, to be repeated every 
second hour, for the space of ten or twelve hours, when a 
mild laxative dose, aided by an injection of flaxseed tea may 
be used ; after which repeat the bath. 

The condition of the abdomen, in the mean time, may be 
soothed by the application of a flannel or other soft woolen 
cloth, tightly wrung out of hot water, and large enough to 
cover nearly her whole front. If the pain and fever still 
continue, and the pulse become less frequent at the expira- 
tion of twelve hours, the patient may be again bled from the 
arm to an extent sufficient to make a decided impression, but 
if the pulse remain frequent, let a sufficient quantity of blood 
be drawn by cups, as nearly as practicable over the pain, 
or apply twenty or thirty Spanish leeches, if they can be 
had, if not, fifty or sixty of those common to this country. 

After this superficial bleeding, again repeat the vapor bath 



PUERPERAL FEVER. 48 T 



fore and continue the use of the dovers powder, &c, still 
continuing the application of the hot cloths, and repeat the 
injection once or oftener in the next twelve hours. The 
blood-letting or cupping, &c, may be continued until the 
violence of the symptoms abate, after which the case may be 
treated as if it had been fever in any other form, remember- 
ing however, that a woman after parturition ought not to be 
much on her feet, or sit in an erect position much of her time 
till after the expiration of her month. It is possible after the 
violence of the symptoms have subsided, that the case might 
assume typhoid appearances. Then let the treatment be 
such as would be proper under similar appearances, in any 
other form of fever. 

It may not be out of place to add here, that if convulsions 
occur in the time of labor, under all circumstances pertain- 
ing to such a condition of things, very decisive blood-letting 
is necessary to save the life of the patient. One, two or 
three blood-lettings repeated, as indicated by the state of the 
pulse, have been necessary in all the cases that have come 
under our observation, and we have taken three, four, five or 
six pints, in different instances, and have been successful in 
every case. 

A severe case of puerperal fever, is generally protracted 
long enough, to reduce the patient very much - T and the con- 
valesence needs to be guarded. If repeated blisters shall 
have been necessary in managing the case, it will very much 
contribute to her safety, to continue their use, till the patient 
shall be sensible of increasing strength. Such diet as may 
suit at the first, when she is beginning to improve, had better 
be continued, till she is able to sit up without much incon- 
venience. 



31 



482 PHLEGMASIA ALBA DOLENS. 



CHAPTER XLI. 

PHLEGMASIA ALBA DOLENS, VULGARLY CALLED MILK LEG. 



A swelling of one and sometimes of both the lower extre- 
mities, occasionally happens after child birth. In most instances 
a pain or tenderness is felt in the calf of the leg, extending up 
and down, which is followed by a swelling of the limb, until 
the whole extent of it, from the hip to the toes is greatly en- 
larged ; which, in the course of twenty-four or thirty-six 
hours, expands the limb to twice or thrice its natural size. 

After the swelling shall have taken place, the skin presents 
a pale, white, glossy color ; is hot and tense, not being pitted 
by pressure with the finger. The swelled limb becomes ex- 
quisitely painful and tender, the patient not being able to 
move her body or leg. Her pulse is seldom below one hun- 
dred and twenty, often one hundred and forty in a minute. 
Her tongue is white and moist, with thirst and loss of appe- 
tite. The lochial discharge, and lacteal secretion, are in 
some instances suppressed, in others they continue. The in- 
guinal glands are swelled, painful and tender, and the abdo- 
men somewhat enlarged. 

TREATMENT. 

If the pulse be strong, blood-letting once or twice may be 
necessary. If the glands in the groin be very painful, leech- 
es may be applied over them. The patient's bowels should 
be kept -in comfortable condition. 



PHLEGMASIA ALBA DOLENS. 483 

Professor Davis, of the London University, has successful- 
ly proved, that the disease is consequent on a congestion of 
the veins of the limb affected. Our practice has led us to 
adopt his theory. Therefore, after having bled the patient 
as far as it may be necessary, we would apply the vapor bath 
decisively ; letting the affected limb be so held by a female 
assistant, that it shall receive at least its full share of the heat- 
ed air ; and it is better that the bath should be repeated at 
least once in every twenty-four hours. As a local remedy, 
we apply strips of leather, or cloth about two and a half 
inches wide, of suitable length; one to reach from the groin 
to the knee, the other from the knee to the ankle to be spread ; 
with the mercurial plaster, and laid upon the inner side c* 
the limb, so as to cover very nearly the whole length of 
the veins and lymphatics ; which done, we wrap the limb 
in two pieces of silk oil cloth, cut in shapes to fit con- 
veniently; around the whole we apply a bandage, mode- 
rately tight. 

As the plaster is not very adhesive, it can be retired 
when the bath is used, and replaced after its application. 
In all other respects, that is, the medication and nursing, 
may be the same as that which is proper in puerperal 
fever. 

Convalesence commonly progresses slowly, after an attack 
of milk leg. The patient should therefore be cautious as to 
her diet, confining herself to such articles as are known to 
suit ; and preferring such of them as have the best effect on 
the bowels. 

Very often the patient, after getting up, experiences more 
or less lameness in the affected limb, especially after much 
walking, or long standing on her feet • she should be careful 
in these particulars, and use much friction. 



484 SUPPRESSION, ETC. OF URINE. 



CHAPTER XLII. 

SUPPRESSION, RETENTION, AND INCONTINENCE OF URINE. 

This affection, in most instances, is no more than a symp- 
tom of some other and more serious disease. 

TREATMENT. 

If there should be present considerable signs of fever, with 
tense pulse, let the patient be bled according to circumstan- 
ces, to be followed by a gentle purge, after which apply the 
vapor bath ; which might be repeated once or twice in 
twenty-four hours. During the intervals of the bathing, let 
him take once in three or four hours, from three to five grains 
of super, carbonate soda, and drink moderately of an infu- 
sion of uva ursi, made with about one drachm to the pint of 
water, which should be kept nearly boiling hot, for fifteen 
or twenty minutes, and of which the patient might drink 
from one to two pints, in twenty-four hours ; or he may 
drink a tea made of horse-mint, to the same amount. He 
might also use the minimae pills, repeated two or three times 
in twenty-four hours. 

If this simple treatment should fail of affording relief, some 
serious affection of the brain or of the nervous centres which 
preside over the functional action of the abdominal viscera, 
particularly of the kidney, is to be apprehended. 

RETENTION OF URINE. 

This affection is often merely accidental, and might be 
corrected by the same remedies, which are proper in suppres- 



SUPPRESSION, ETC. OF URINE. 485 

sion of urine. If they should fail, the only proper alterna- 
tive, is a recourse to the catheter. 

INCONTINENCE OF URINE. 

This inconvenience commonly befalls children, and often 
happens in consequence of negligent nursing. Possibly the 
child or the youth may be a sound sleeper, and discharge his 
urine in a dream. 

If no other cause exists to keep up this filthy habit, no- 
thing more will be necessary than to wake up the patient, 
and cause him to urinate every third or fourth hour, through 
the night. 

If it should be consequent on an unnatural relaxation or 
want of sensibility of the urethra, give the patient ten drops 
of the saturated tincture of cantharides, three or four times in 
twenty-four hours, gradually increasing the dose, up to forty 
or fifty drops ; still continuing to wake him up nightly, as 
before advised. 

If the patient be of feeble constitution, and particularly if 
his face or feet are inclined to swell — in addition to the man- 
agement above advised, he should take three or four times a 
day, eight or ten grains of the precipitated carbonate of iron. 
It may be mixed, when taken, in a little molasses, or be 
washed down with a spoonful or two of cold water. It 
might be useful to drink a moderate portion, daily, of a de- 
coction or tea of sweet fern, 



486 eoLic or infants. 



CHAPTER XLIII. 

COLIC OF INFANTS. 

There is a species of colic, which occurs during infancy, 
under circumstances where we have no reason to suspect, as 
its cause, any disturbance of the digestive function either 
from the bad quality or undue quantity of the food. We 
have known it to occur daily, during the first month or two. 
and nearly at the same period of the day — generally towards 
the latter part of the afternoon. In slight attacks, the infant 
becomes suddenly very fretful : draws up its knees towards 
the abdomen, and cries for a few minutes; and then resumes 
its usual quiet state, as though nothing had occurred. The 
attacks may be repeated at shorter or longer intervals, and 
seldom cease permanently, or for any length of time, until a 
portion of gas is discharged by the mouth or pexanum, or an 
evacuation of foeces, often thin and frothy, occurs. In more 
violent attacks, the infant commences, suddenly, to utter 
sharp, piercing screams, which are often long continued or 
only interrupted by a few moments of quiet ; the knees are 
forcibly drawn up, or its legs are drawn up and extended in 
rapid succession ; the trunk of its body is occasionally, forci- 
bly extended, with the head thrown back, and the hands 
firmly clenched. The expression of its countenance indi- 
cates severe suffering : its face being occasionally flushed or 
covered with large drops of perspiration. The abdomen is 
often distended, tense and tympanitic, or presents an irregular 
or knotted surface. No pain is induced by pressure upon any 
part of the abdomen ; gentle pressure and frictions appear, 
indeed, in most cases, to afford decided relief. 



COLIC OF INFANTS. 487 



Notwithstanding the severity of the paroxysms, in this 
form of infantile colic, the child, immediately upon their ces- 
sation, is quiet, cheerful, and playful, and exhibits nothing in 
its appearance, to indicate the severity of its recent suffer- 
ings ; its appetite is seldom impaired, the digestive and nu- 
tritive functions are, in no degree, disturbed or interrupted, 
and the general health, seems, often, actually to improve ; as. 
Dr. Dewees very correctly remarks, some of the fattest and 
healthiest children are those affected with it. 

During the paroxysms, the warm bath and warm fomenta- 
tions to the abdomen, are among our most valuable reme- 
dies; we have found prompt relief, often to be produced, by 
applying to the abdomen, after immersion in the warm bath, 
a cataplasm, formed of hops, steeped in warm water, and 
enclosed in a thin gauze bag. The bowels should be opened 
by an injection of warm water, to which a few grains of as- 
safoetida, dissolved in milk, may be advantageously added. 
Internally we have occasionally administered, with prompt 
relief, a few grains of camphor water, or of spirits of tur- 
pentine, rubbed up with sugar. Three to five drops of 
spirits of turpentine may be given to an infant, and repeated, 
every one or two, or three hours, according to the urgency 
of the case. When, however, the paroxysm is one of un- 
common severity, and does not promptly yield to the means 
that have been enumerated, we have never hesitated to ad- 
minister an opiate, either by injection or by the mouth, grad- 
uating the dose according to the age of the infant, and care- 
fully watching its effects, before venturing upon its repeti- 
tion. We have been much pleased with the action, in the 
colic of infants, of a watery infusion of opium : — five grains 
of opium may be infused, four. hours in two fluid ounces of 
water ; the infusion being then filtered, ten grains of bicar- 
bonate of soda, are to be added j of this, ten drops may be 
ffiven to a child, within the mouth, in a Little sweetened 



488 COLIC OF INFANTS. 



aniseed water — the same dose being repeated after an hour, 
if necessary. (See Condie, 193, &c.) 

Perhaps there is no remedy better than the following, viz : 
Take calomel ten grains, ipecacuanha ten grains, morphia 
one grain, one ounce of loaf sugar, and ten drops of the es- 
sential oil of anise. Carefully powder four or six grains of 
red sanders ; then, grind the six articles together until very 
intimately mixed. Of this preparation give, to an infant one 
or two weeks old, one or two grains and repeat every half 
hour, until the child is easy. As it grows older, the dose 
may be gradually enlarged. Of this preparation, two grains 
contain the twenty-fifth part of a grain of calomel, the same 
of ipecacuanha ; and the two hundred and fiftieth part of a 
grain of morphia, which is equal to half a drop of laudanum. 

Mothers are too prone to teach infants to eat articles of 
diet, such as please their own palates. The breast furnishes 
the proper food for babes. If this fail, and the child is fed 
as a matter of necessity, sweet milk and water, with a little 
sugar, is as strong nourishment as an infant can digest. As 
it grows older, a very small portion of wheat flour or arrow 
root starch may be added. 

If an improper diet shall have been the cause of colic, a 
discontinuance of the imprudence will relieve the child, per- 
haps, without any kind of medicine. 



CHOLERA INFANTUM. 489 



CHAPTER XL1Y. 

CHOLERA INFANTUM, OR SUMMER SICKNESS OF CHILDREN, 



Cholera infantum occurs most frequently in large cities, 
and the cases are more numerous and fatal in those parts of 
the cities, which are least cleanly, with deficient ventilation. 
There are also country places in low sultry situations, in 
which, this truly alarming disease occurs, at some period, al- 
most every summer. 

An insalubrious atmosphere causes debility. The chil- 
dren kick off the bed-clothes, almost every night. The su- 
perficial capillaries are brought into a condition of atony. At 
length the circulation is introverted and the fluids of the sys- 
tem run off by the bowels with such rapidity, that unless the 
morbid determination can be speedily arrested, the child so 
affected will be lost. 

This disease usually commences with a profuse diarrhoea. 
The stools are often green or yellow ; more commonly, how- 
ever, they are of a light color and very thin. In a short time 
vomiting also takes place. The stomach becomes exceed- 
ingly irritable, rejecting every thing taken into it. The child 
shows intense desire for cold water, which in like manner is 
immediately rejected. 

The pulse in the commencement of the attack, is quick, 
frequent, small, and generally tense. By the diminution of 
the capillary action, an accumulation of sensorial power is 
produced, which is determined upon the vascular system, 
particularly upon those branches which lead to the abdom- 
inal viscera. A fever is set up in those structures, which is 



490 CHOLERA INFANTUM. 



evinced by the state of the pulse, which is quick, frequent 
and small, demonstrating the limited condition of the circu- 
lation ; it is also tense. We were particularly careful in our 
remarks on the pulse to specify a tense pulse as a most cer- 
tain indication of the necessity of blood-letting ; inasmuch as 
it invariably demonstrates an injected condition of the arte- 
ries. In an instance of cholera infantum, the arteries are 
tense from the common cause, a constricted state of the ca- 
pillaries. But those structures are so much enfeebled, that 
they would fail to react after a bleeding, and therefore in 
most instances the case would be made worse by loss of blood. 

The tongue is covered with slimy mucus, corresponding 
to the relaxed condition of the mucous lining of the alimen- 
tary canal. If the child is not immediately relieved, in the 
course of a few days the skin becomes dry and harsh. The 
debility of the capillaries becomes so great that they cease to 
perform the function of perspiration ; heat accumulates in 
the skin from deficiency of the natural medium of evapora- 
tion. These last remarks, however, apply more particularly 
to the head and abdomen. The extremities retain their nat- 
ural temperature till the prostration is very great, and then 
are decidedly cold. There is in every instance intense thirst, 
and a paroxysm of fever occurs every evening, when the 
child becomes more fretful, moans, requires frequent change 
of posture, draws up its knees, and sometimes screams out 
with pain. In some instances the abdomen becomes tumid 
and is tender to the touch. In others the attack is so vio- 
lent and the prostration so sudden, that the patient dies 
within the first twenty-four hours. Sometimes also the pa- 
tient is affected at an early period with delirium: his eyes 
become red and look wild ; his head is tossed backwards and 
forwards ; and he tries to bite or scratch his nurse. 

In general the disease runs a protracted course. The pa- 
tient becomes greatly emaciated ; his eyes languid, hollow 
and glassy; his countenance pale and shrunken ; his nose 



CHOLERA INFANTUM. 491 



sharp and pointed, and his lips thin, dry and shriveled ; the 
skin upon his forehead smooth and shining, as if stretched 
tightly over the bone. The child lies as if constantly dozing, 
with his eyes half closed, and appears to be so insensible, 
that flies may alight upon his half exposed eye-balls, without 
exciting any evidence of consciousness. 

Dr. Condie, in a highly respectable work published in 1844 
on the diseases of children, says "the disease is evidently 
dependent for its production, upon the action of heated, con- 
fined and impure atmosphere, directly upon the skin, and 
indirectly upon the digestive mucous surface, at a period, 
when the latter is already strongly predisposed to disease 
from the effects of dentition, and from the increased devel- 
opment and activity of the muciparous follicles which takes 
place at that period." " The influence of a high atmospheric 
temperature, in tKe production of cholera infantum, is shown 
by the fact, that its prevalence is always in proportion to the 
heat of the summer — increasing, and becoming more fatal, 
with the rise of the thermometer, and declining with the first 
appearance of cool weather in the autumn. A few hot days 
in succession, in the month of May, are sufficient to produce 
it ; while, during the height of its prevalence, a short period 
of cool weather, will diminish, if not entirely suppress it. 
In those * infants, who have been prematurely deprived of 
their natural aliment, or whose diet is composed of crude, 
indigestible, stimulating, or otherwise unwholesome articles, 
a heated and confined atmosphere would appear to be alone 
sufficient for the production of the disease ; but the extensive 
prevalence of the cholera of infants, during the summer 
months, is not dependent alone upon the influence of a high 
atmospheric temperature, and confined to an impure air. 
Hence it is almost exclusively confined to the larger and 
more crowded cities, of the middle and southern states ; and 
in these, it is especially prevalent and destructive to life, 
among the children of the poorer classes, inhabiting small, 



492 CHOLERA INFANTUM. 

ill-ventilated houses, situated in narrow, confined lanes, 
courts and alleys, or in situations abounding with accumula- 
tions of filth. When it occurs in the country, which is 
rarely the case, it is almost exclusively in low, damp, and 
otherwise unhealthy situations. By many writers, dentition 
and errors in diet, are enumerated among the causes of chol- 
era infantum. They are unquestionably to be viewed, in 
many cases as predisposing, and in others, as exciting causes ; 
but we have, in no instance, known an attack of genuine 
cholera infantum to occur, without exposure to the influence 
of a heated, stagnant, and more or less impure atmosphere ; 
and this alone, in the great majority of cases, would appear 
to be the sole cause of the attack." 

We consider the account of this disease as thus given by 
Dr. Condie, as being strictly correct, and in perfect consent 
with the views which we wish to inculcate. It follows, 
therefore, that the first step to be taken in order to effect a 
cure, should be to recover and establish the excitement of 
the skin. 

Let the child be washed in water as hot as it can be borne 
without giving pain, using a cloth with good soap. The 
cleansing operation should be performed effectually, but with 
some degree of expedition. 

Having washed off the soap, the 'whole surface should be 
carefully wiped with considerable friction, so as to redden 
the whole surface. The same treatment should be repeated 
three times a day; in the morning to prevent the occurrence 
of any degree of chill ; again in the middle of the day to af- 
ford a substitute for the natural perspiration which will cor- 
rect the existing appearances of fever, and at night to prevent 
a return of the introversion of the circulation, which without 
this precaution takes place more or less every night. 

This kind of attention to the skin will in mild cases often 
be sufficient, without any internal remedy. The child, how- 
ever, if it be at the breast, should be prevented from taking 



CHOLERA INFANTTM. 493 



any additional food. It might be permitted to drink gum 
water, say an ounce of gum arabic dissolved in a pint of wa- 
ter, or it might use the whey of new milk, turned by the ad- 
dition of an equal quantity of sour milk, mingled with it and 
set on alight fire, till they turn. This may be sweetened a 
little, adding a small portion of gum. 

The patient should not sleep too near to the ground. If 
practicable prefer a second story. His bed should not be too 
soft, and the room had better be large and airy. His night 
dress should be made of flannel, with a body and legs, so as 
to prevent its being kicked off, whilst the child sleeps. 

If the washing and management as above advised should 
not be, at once, effectual ; apply the vapor bath, every morn- 
ing and evening, as an auxiliary remedy for the skin, and in- 
ternally give one-fifth or one-sixth of a grain of calomel, to 
which add the same quantity of ipecacuanha, the two articles 
rubbed up with a little loaf sugar, and repeat every second 
or third hour. If, however, the stomach be irritable and 
reject the medicine in this form, use the calomel only, 
and when carofully ground up with the sugar, put the powder 
so prepared, in a dry state, upon the child's tongue. 

After using the vapor bath, continue to wipe off the sweat, 
until it ceases. Then rub the skin extensively with hog's 
lard made a little pungent by stewing it over a very mode- 
rate heat, having first added a little cayenne or common red 
pepper, and a moderate portion of salt. 

Those who have the means, will act prudently, to let their 
children spend their first two or three summers in healthful 
regions. Such as are compelled to remain with their fami- 
lies in sickly situations, should be careful to keep a good fire 
night and morning, and all day during wet and cold weather. 

In treating sick colored children, as well as those that are 
white, if called early and their condition will certainly war- 
rant a safe reaction, we let blood to prevent congestion ; then 
order the washing,. wiping, anointing with the liniment made 



494 CHOLERA INFANTUM. 



stimulant with the pepper, (we mean cayenne pepper and 
salt, ) which should be accompanied with friction as severe as 
can be borne, and then wiped off very carefully. These 
steps having been carefully taken, we give to very young 
children calomel and ipecacuanha, of each one-tenth of a 
grain ground up in sugar, repeating the dose every second 
hour till it produces decisive effect ; afterwards regulating 
the doses according to their effect. To children from six-to 
twelve months old, half a grain of each, advancing to a grain 
or two grains till the effect shall be satisfactory. 

If the case will not admit of blood-letting, we rely on the 
calomel and ipecacuanha. Whether we bleed or not, we 
order the washing, liniment and friction to be performed at 
the fire, to get the benefit of a pungent heat every evening 
and morning, and as many times in the day as the child shall 
become too hot or too cold, or very restless. All cases of 
fevers befalling children, and indeed persons of whatever 
age, ought to be treated according to these views ; adjusting 
the medication and management to the ages and various de- 
grees of strength of the different patients. 



TABES MESENTERICA. 495 



CHAPTER XLV. 

TABES MESENTERICA. 

In this disease there is an enlargement of the abdomen ; 
attended by great emaciation of the whole body. It com- 
mences in an irregular state of the bowels. After a while, 
the strength of the patient fails ; his extremities and his face 
become emaciated, whilst at the same time, his belly is be- 
coming larger. Sometimes his appetite is ravenous ; at other 
times he is indifferent about eating. He has great thirst and 
frequently complains of pains in the bowels. Some in this 
affection, show signs of fever ; others are quite free from 
such symptoms, except that there is a febrile attack during 
the night, which goes off with a perspiration towards morn- 
ing. With some the abdomen feels knotty and doughy ; 
sometimes it feels tight and drum-like. Commonly, at first 
the enlargement of the abdomen, is produced by wind, in 
consequence of the weakness of the bowels; but as the dis- 
ease progresses, an effusion takes place in the cavity, and 
the glands of the mesentery become enlarged. By and by 
the child is exhausted by excessive purging, or dies by disease 
set up in some other part or organ of the body — commonly 
the brain or the lungs. 

This disease is the consequence of sub-acute inflammation 
neglected, or improperly treated. 

TREATMENT. 

If the case be recent, let the patient take one-fourth of a 
grain of ipecacuanha, together with the same quantity of 



496 TABES MESENTERICA. 



calomel, two, three or four times a day, or as often as his 
bowels will bear it, not to be too much purged. Let this 
treatment be continued about one week. Then give three 
doses a day of the syrup of blue mass, rhubarb and ipecacu- 
anha, so as to regulate the bowels properly. In the mean- 
time, his skin be treated with the pepper liniment and fric- 
tion,* aided by heat, in imitation of the practice advised for 
the management of dyspepsia. 

When this affection shall have been of long standing, the 
glands of the mesentery become so much enlarged, that it 
unavoidably requires much time to accomplish a cure. Those 
children who are the subjects of it, are almost without excep- 
tion, intemperate eaters. While under treatment, therefore, 
they must be lightly fed, and for months they must be kept 
under great restraint after it may be thought that the disease 
is removed. Without these precautions, the patient will be 
the subject of relapse. The original cause of the malady, 
being permitted to act on a system habitually under its influ- 
ence, common sense must perceive the danger of a return of 
all its original mischiefs. 



GANGRENE OF THE MOUTH. 49T 



CHAPTER XLVL 

GANGRENE OF THE MOUTH. 

There is a painful and not unfrequently fatal disease, which 
has occasionally appeared in our larger cities, and sometimes 
in country places, known by the name of gangrene of the 
mouth, water canker, cancrum oris, &c. 

This remarkable affection is not the termination of ordina- 
ry inflammation, but often comes on without pain, heat or 
redness ; yet with a hard swelling in one or both cheeks, 
with so little tenderness, that " the patient seems almost un- 
conscious of it ; and but for the enlargement being obvious 
to the eye, the mischief would probably escape notice alto- 
gether in its early stage. Indeed, as it is, the tumefaction is 
occasionally mistaken for affections of a much less serious 
description. The skin of the cheek has a peculiar glossy or 
waxy appearance. On examination of the mouth, we detect 
a whitish or ash-colored eschar, without any inflammatory 
redness of the surrounding membrane ; generally in the cen- 
tre of the cheek, or in the commissure of this part and the 
lower jaw. The gums look pale and spongy. There may 
be a certain degree of langour, dullness, or slight feverishness: 
but not less frequently there is nothing to call particular at- 
tention to the general health of the patient. Such are the 
principal phenomena of the first stage of the disease. As it 
advances, the slough spreads rapidly over the interior of the 
cheek and lip, and invades the gums. Saliva escapes in 
great quantity ; at first clear, afterwards mixed with dirty 
sanious matter, which has a horrible foetor. About the same 
time, the outside of the cheek presents a pale, shy spot, which 
soon becomes livid and sphacelates. The extension of the- 
32 



498 GANGRENE OF THE MOUTH. 

disease to the bony structure is evidenced by the loossening 
of the teeth, which are soon thrown off with portions of the 
alveolar process. The fluid discharged appears to have a 
corrosive quality ; for the angles of the mouth and the lower 
lip, sometimes become new centres of mortification. We 
have known both sides of the face attacked in the same in- 
dividual ; and there are cases on record, in which all of the 
soft parts of the face, as well as the upper maxillary bones, 
the palatal, the nasal, and even the ethmoid, were involved 
in the destruction." 

The preceding description of the disease by Dr. Simonds, 
as observed by him in Great Britain, corrresponds entirely 
with the appearances in this country, and especially in Phil- 
adelphia city, by Dr. B. H. Coates, who had charge of one 
hundred and seventy cases within three months in the chil- 
dren's asylum. 

TREATMENT. 

Besides those internal remedies, which suggest themselves 
for the correction of the stomach and bowels, Dr. Coates 
found the following local application to be far more effica- 
cious than any other: Sulphate of copper, 2 dr.; powdered 
cinchona, h. oz.; water, 4 oz.; to be applied twice a day to 
the full extent of the ulcerations and excoriations. The cin- 
chona is not absolutely necessary, but serves to retain the 
sulphate longer in contract with the edges of the gums. 
Simple ulceration and small gangrenes, adds Dr. Coates, as 
well as troublesome excoriations, when not in the last stage, 
yielded promptly to this remedy; the good effect being gene- 
rally visible from the first application. 

" The separation of a portion of the periosteum from the 
fangs, within the socket, which was universally found, when- 
ever the tooth was loose, among two or three hundred speci- 
mens, proved the existence of the disease in a deep narrow 
crevice, into which it was impossible, by any contrivance, to 
insinuate the lotion. This cavity was laid open by extract- 



GANGRENE OF THE MOUTH. 499 

ing the tooth; and when the remedy was applied, the sana- 
tory effect was surprisingly prompt. The universal rule was 
to extract all teeth, the moment they were discovered to be 
in the slightest degree loose, and the blue wash above de- 
scribed became the standing remedy. 7 ' In addition howev- 
er, the following prescription derived from the late Dr. Par- 
ish, will be found extremely beneficial : Sulphate of zinc, 1 
dr.; water, 2 dr.; and then add of pure honey and tincture of 
myrrh, 2oz.; to be applied the same as the preceding lotion. 

As often as we have met instances of this affection in chil- 
dren, the parents and friends were disposed to attribute them, 
to an injudicious use of calomel; greatly to the disparage- 
ment of the attending physician. It is probable that the pe- 
culiar tendency of mercurial action to affect the mouth, may 
hasten, and in some instances excite the 'morbid state of the 
lining membrane of the alveolar processes, which in our opin- 
ion, is the portion of structure that first sphacelates. The 
disease is of a secondary character, and befals no child whose 
cuticular surface is not so affected as to exhibit the " pecu- 
liar, glossy and waxy appearance," noted in the foregoing 
description. We have known it to occur in a case where 
not a particle of mercury had been used. We have met it 
once in a very old man, over seventy years, who had taken 
no medicine of any kind. And we knew one instance, a 
girl ten years old, sick with typhoid fever, to whom five 
grains of calomel were given as a gentle apperient. It acted 
as it was expected, on the bowels. The next day her gum 
began to melt away, at the root of a decayed tooth, and the 
gangrene progressed in the usual manner. The action of 
her skin on both cheeks and on her forehead, was "glossy 
and waxy " before the calomel was administered, and we 
advised against its employment in the case, on that account. 

We approve the practice of Dr. Coates, as also that of Dr., 
Parish ; but earnestly recommend the use of the vapor bath 
as a most important auxiliary in ievery case of this sort ; 
which should be applied morning and evening. 



500 CONCLUDING REMARKS. 



CHAPTER XLYII. 
CONCLUDING REMARKS. 

We have selected the foregoing diseases, and given our 
method of treating them ; believing that they will afford all- 
necessary instruction to intelligent families and individuals, 
how to anticipate and prevent most instances of threatened 
danger from sickness ; and how to manage cases which they 
may have permitted to occur, through inattention to premon- 
itory symptoms, or which may have been unavoidable. By 
a careful attention to the letters, which we have introduced 
for the purpose of emboldening our readers in the use of the 
bath, they will receive much practical information, all of 
which is trustworthy. Excepting three or four persons, we 
were personally acquainted with the writers, and were well 
enough informed respecting the moral character and standing 
of them all, to feel justified in indorsing their statements, 
without exception. On making the trial, each repetition 
will afford additional information and encouragement to per- 
severe, as there may be occasion. As to the profession, if 
physicians shall candidly and confidently pursue the practice 
submitted, in the cases presented in the practical part of our 
work, they will be prepared, without further instructions 
from us, to extend the application of our principles with in- 
cessant improvement, throughout the whole range of medi- 
cine and surgery. 

If the young physician will take Mcintosh or any other 
standard work, on the Theory and Practice of Medicine, as 
his vade vecum, a::d associate the use of the vapor bath. 



CONCLUDING REMARKS. 501 

agreeably to our instructions respecting it, he will soon learn 
the truth of the above statement. And we have no doubt 
that the time will come, when the community will require 
that course. ' 

If our publications respecting the efficacy of the vapor 
bath, shall be confirmed by a sufficient number of trials, we 
can come to no other conclusion but this one, that the doc- 
trines which we inculcate on the subject of fever, are true 
and trust worthy ; that the capillaries of the external surface 
are greatly concerned in its production ; and when disease 
shall have occurred, a concurrence of their agency, is indis- 
pensable in effecting its cure. 



APPENDIX. 



HYDROPATHY, OR WATER CURE. 



Hydropathy, or water cure, by many may be considered 
directly in opposition to the views which we inculcate. We 
have therefore thought it necessary, to submit the following 
remarks on the subject. 

We have laid it down as a practical rule, that in an attempt 
to correct congestion, the system must be brought into the 
condition of direct debility; that is, the arterial action, must 
be reduced in power, to a degree lower than is natural in the 
case under treatment. This, when necessary, we secure by 
letting blood, or by the vapor bath, or both. In the water 
cure Mr. Priessnitz has succeeded in accomplishing it, in 
some sort, by the external and internal application of cold 
water. But it is a slow and uncomfortable mode of proce- 
dure. To effect cures in his way, it requires sometimes two, 
oftener four, five, or six months j and in some instances, a 
year or a year and a half,^or two years. Whereas if the ca- 
pillaries were aided by an appropriate application of dry heat, 
the same cures might be performed in one-fourth part of the 
time. The arterial action being kept in a subdued state, the 
veins and lymphatics gain an ascendancy and take up 
and retire the misplaced blood — the effect of congestion, 
as well as the material deposited by a morbid application 



504 APPENDIX. 



of the function of nutrition. He is not apprised of the 
fact, that such a thorough and long continued reduction of 
the temperature of his patients, is the cause of so great delay 
in accomplishing his cures. He has learned by observation 
and experience, that wrapping in wet sheets and repeating 
the cold bath, followed by a packing up in wet and dry 
clothes, will produce a profuse sweat ; and that the sweat is 
often dark colored, emitting uncommon odors. It was quite 
natural for him, therefore, to conclude, that he washes and 
sweats out the morbific matter, which constitutes the vari- 
ous diseases under his treatment ; especially, since the doc- 
tors who have visited his establishment, have given their 
sanction to this opinion. 

We are satisfied with the evidences of Mr. Priessnitz's 
strength of intellect and of the accuracy of his discernment. 
These, have enabled him to associate his douche, his plung- 
ing bath, his half bath, his sheet, bath, his sitting bath, his 
head bath, his foot bath, and his packing up for the sweat, 
each with the peculiar symptoms for which he has found it 
appropriate : and this adjustment is the only imitation of sci- 
ence, which we have been able to detect in the whole mat- 
ter. He goes the round of this little circle, over and over, 
and patiently, with confidence awaits the issue. His pa- 
tients, which are always select, are trained to the course, and 
with like confidence tamely endure their amphibious condi- 
tion, and submit, till nature, aided by washing, by dilution 
and starvation, institutes for herself, her own method of cure. 
It seems to be a curiously bewitching species of empiricism, 
which is destined, nevertheless, to introduce a beneficial 
improvement into the department of medical science. 

An atony or faltering of the capillaries of the skin, is the 
first link of the chain of events which occur, in the estab- 
lishment of fever. In chronic disease, this debility marked 
by paleness, that is, by a deficiency v in the circulation, be- 
comes habitual, in a degree corresponding to the deficiency 



APPENDIX. 505 



f o'f the superficial circulation ; the capillaries of the skin hav- 
ing become disabled, present an interruption to the general 
circle. The arterial structures in course become injected to 
unnatural fullness, and irritations and congestions are set up, 
giving rise to the many forms of disease, which afflict man- 
kind. It will be perceived, therefore, that we charge all the 
irritations and organic mischiefs to the account of the heart 
and arteries, whilst the origin of the whole is a disability in 
the skin to perform its functions. The skin, thus nearly 
destitute of the circulation, becomes constricted and imper- 
vious, forming a tightly fitted bandage, which makes unna- 
tural pressure on the cellular structures subjacent to it, and 
increase the tendency to irritation to an indefinite degree. 

In attempting to correct such a state of things, it would 
seem obvious, that a restoration of the capillaries to their 
natural state, ought to be the first intention of the physician. 

This Mr. Priessnitz slowly accomplishes, without knowing 
the philosophy of it, by extensive and almost incessant fric- 
tion. The water may serve in some degree to soften the 
capillaries and favor their expansion. But the low tempera- 
ture which he prefers considerably counteracts the effect of 
his rubbing and wiping operations. Nevertheless, for the 
restoration of the languid structures of the surface, very 
much may be done by stern friction. 

In the year 1809, we attended a case of rheumatism. The 
disease had fastened on the gentleman's knees, which were 
greatly enlarged, exceedingly painful and incorrigibly stiff ; 
insomuch, that he could not walk one step. We were aided 
by one of the ablest physicians of Lynchburg, Virginia. Our 
united efforts were unavailing, although we used the most 
promising agents, external and internal. The patient be- 
came tired of our attentions, and asked permission to send 
fifty miles for a black man, who had acquired reputation in 
treating old rheumatic affections. By request we remained 
in attendance to witness his operations. It was quite amu- 



506 APPENDIX. 



sing to see how politely the black doctor entered the sick 
room, with two large corn cobs, in a bowl of salt and water. 
He commenced his operation, plying his cobs, with a seve- 
rity rough enough for the treatment of a horse. The patient 
was alarmed and would willingly have given up all as lost. 
But we urged him to persevere. He did so, and in two 
weeks he was able to walk. He was cured by severe fric- 
tion with two corn-cobs. Since that time, we have greatly 
relied on that kind of practice. To the reiterated friction, 
more than to the cold water, the patients of Mr. Priessnitz are 
indebted for the relief he affords them. 

The occurrence of the circumstances which they so much 
delight in, and which they call the crises, satisfies us of the 
deficiency of the whole plan, and proves, that his cases suffer 
from the want of well-timed depletion. When by the resus- 
citation of the capillaries, the absorbents begin fairly to take 
up the misplaced material that constitutes congestion or hy- 
pertrophy when it exists, the particles so taken up, are com- 
mingled with the blood, and the blood-vessels are irritated by 
it. A feverish disposition is by that circumstance kept up ; 
and the old irritations are removed, whilst the system remains 
in a state corresponding to what it would be, in a slow 
fever ; and the ultimate convalescence is ushered in by ab- 
scesses, boils, &c. in both cases. 

. The employment of the vapor bath, would revive the ca- 
pillaries much more speedily and with incomparably less dis- 
comfort, than cold water. In a case of long standing, the 
capillaries are constricted almost to a state of solidity; the 
skin feels hard and inelastic,, and is pale through the defi- 
ciency of the circulation. Heat expands the vessels, renders 
the blood more fluid, and excites the whole structure to ac- 
tion. Besides, the blood itself is endowed with a degree of 
vitality, and distinctly evinces an appetence to a warm tem- 
perature. This is proved by the following experiment : 

In performing the common operation of blood-letting, use 



APPENDIX. 507 



a White bowl. Let the stream of blood fall against the op- 
posite side of the bowl. Then moving it a little briskly, 
from right to left, cause the blood to spread as it runs down 
the side of the vessel, so as to make a red track about two 
inches Wide. Continue this little manipulation, till the side 
of the bowl, that is the blood's track, shall have become 
warm j then hold the bowl still, and let the blood run down 
about the middle of the track ; and on a nice inspection it 
will be seen by any one, that the red particles will run from 
both sides of the red track to the stream of warm blood — 
horizontally, obliquely, upwards and downwards, chasing 
trie Warm current, as the operator shall choose to ehange the 
stream from side to side. Moreover, the red particles rise 
from the blood in the bowl to the distance of half an inch, 
and in curved lines run up and meet the descending stream, 
showing satisfactorily, their appetence to a warm temperature. 
We have effected many cures of rheumatisms and other 
obstinate chronic diseases, by the use of our vapor bath and 
friction, aided by appropriate depletion, in much less time ; 
subjecting our patients to much less inconvenience than ap- 
pears to be necessary, in performing any water cure, the his- 
tory of which has come to our knowledge. Time will deter- 
mine the comparative merit of heat and cold ; will ascertain 
the diseases which are most successfully treated, by each of 
the two ; and eventually the world will enjoy the benefit of 
both. It will be known in what cases one should be used 
exclusively; in what others, the two might be associated : 
and again in what others, they may be used alternately, to 
the best advantage. We have witnessed the most satisfac- 
tory benefit, from the alternate use of the. two agents, in a 
most obstinate case of neuralgia, which befell the author's 
wife, in the year 1822. After having several paroxysms of 
intermittent fever, a pain abruptly fastened on her right arm, 
extending from the shoulder to the extremities of the fingers ; 
£n/l for rl^vs w?w inrp.Rsant. Ammonia was applied, so as to 



(OS APPENDIX. 



blister the whole length of the arm ; a plaster of ointment of 
cantharides, was afterwards used. Whilst yet tender from 
the blister, it was wrapped in a plaster of tar. Every kind 
of poultice and lotion, which her many good friends daily 
recommended, were all used without benefit. They were 
applied whilst nearly hot enough to scald, and again quite 
cold: but without effect. Meanwhile, opium. hyosciamus ; 
&c.j and every other hopeful internal remedy, were also used. 
The obstinate pain bade defiance to them ail. After suffer- 
ing an entire month or more, recourse was had to dry heat, 
applied by the use of a shovel of red hot coals. It acted like 
a charm, and continued to be quite comfortably effectual, 
during an -entire week: when very suddenly, heat became 
horribly offensive. Cold water was then poured on the arm ; 
continuing the application for some hours at a time, which 
in its turn, acted as kindly as heat had done whilst it was 
appropriate. After some days the cold water also failed. 
Heat was then again employed, as comfortably as at first, 
but failed again in like manner : when the cold water was 
again effectual. And thus by the use of heat and cold, alter- 
nately employed, in the course of five or six weeks the pa- 
tient was permanently relieved. We must not omit to state, 
however, that all the while, whether in the employment of 
heat, or of cold water, general friction was diligently applied 
with stiff brushes, four times in every twenty-four hours ; 
continuing the brushing at least half an hour at every repe- 
tition. 



A SYNOPTICAL TABLE 



MATERIA MEDICA, 

Therapeutically arranged, by S. K. Jennings, M. D., Profes- 
sor of Materia Medica, Therapeutics, fyc. in the Wash- 
ington College of Baltimore, for the use of his class, 
1838-9. 

CLASS L 

Medicines which act upon the alimentary canal. 

Order 1st — Emetics. Medicines which evacuate the stomach by exciting 
vomiting. 

" 2d — Cathartics. Medicines which expel the foeces by increasing 
the peristaltic motion of the intestines. 

" 3d — Anthelmintics. Medicines which destroy worms, or expel 
them from the body. 

" 4th — Antacids. Medicines which counteract acidity in the stomach. 

" 5th — Demulcents. Medicines which lubricate and protect the 
coats of the alimentary canal. 

■* 6th — Antidotes. Medicines which neutralize poisons when re- 
ceived into the stomach. 

ORDER 1— EMETICS. j posological. 

Ipecacuanha radix, ipecacuanha root, .... J'gr.' i. v. to xx. 

Sanguinaria canadensis, blood root, |gr. ii. iii. tox. 

►Phytolacca decandra, poke root, (syrup,) jdr..ss. to ii. 

Spiraea trifoli'ata, Indian physic, gr. v. x. xx. to xxx. 

Lobelia inflata, Indian tobacco, !gr. v. x. xx. to xxx. 

Euphorbia ipecacuanha, American ipecacuanha, gr. v. x.xx. 

Scilla maritima, squill, jgr. i. iii. vi. xii. 

Sinapis alba, white mustard, gr. xx. to dr. ii. 

Anthemis nobilis, chamomile, — 'gr. xx. to dr. ii. 

Antimomum tartarizatum, emetic tartar, gr. 1-12, \, 1-6, \, h, L to x, 

Sulphas cupri, sulphate of copper, 'gr. v. to xv. 

Sulphas zinci, sulphate of zinc, gr. x. to xxx. 

Hydrargyri sulphas flavus, turpeth mineral, gr. ii. to v. 

Antimonii sulphuretum precip, precip. sulph. of\ 

antimony, . . . gr. v.. to xx... 



510 



APPENDIX. 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED. 



ORDER 2— CATHARTICS. 
Elaterium, wild cucumber, 



Gambogia, gamboge, 

Colocynthidis pulpa, bitter cucumber. 

Scammonia, scammcny, . . 

Radix jalapa, jaZap root, 

Podophyllum peltatum, May apple, 

Aloe socotrina, aloes, 

Radix rhei, rhubarb root, 

Folia sennas, senna haves, 

Juglans cathartica, butternut, (extract,). 
Cassia Marilandica, American senna, . . 

Hydrargyri submurias, calomel, 

Heleborus niger, black helebore, 

Oleum ricini, castor oil, 

Oleum oliva, olive oil, 

Sulphas sodse, Glauber's salts, 

Sulphas potassse, sulphate ofpotassa,. . . 

Tartras potassse, soluble tartar, 

Magnesia, magnesia, 

Sulphas magnesia, epsom salts, 

Sulphur sublimatum, sublimed sulphur, . 

Manna, 

Prunus domestica, prunes, 

ORDER 3— ANTHELMINTICS. 

Spigelia Marilandica, pink root, 

Allium sativum, garlic, 

Melia azedarach,^rafe of China, 



Chenopodium Anthelminticum, worm seed,(decoc. 
Dolichos pruriens, cowage, (see Wood & Bache,) 
Artemisa satonica, Tartarian southernwood,. . . 

Poly podium filix mas, male fern, 

Punica granatum, pomegranate, 

Assafoetida, 

Nicotiana tabacum, tobacco, 

Helleborus foetidus, bears foot, 

Jalapa, jalap, 

Scammonia, scammony, 

Oleum tiglii, croton oil, 

Oleum terebinthinae, oil of turpentine, 

Ferrum, iron, 

Hydrargyrum, mercury, 

Stannum, tin (flings,) 

Sulphur, 

ORDER 4— ANTACIDS. 
Ammoniac subcarbonas, carbonote of ammonia.. 
Liquor ammonias subcarbonatis, sohdion ofsub- 

carb. ammo., 

Spiritus ammonia?, arnmoniated alcohol, 

Cornu ustum, bund hartshorn, 

Testae praeparatae, prepared oysier shells, 



POSOLOGICAL. 

gr. £ to ii. 
m. i. to ii. 
gr. ii. to vi. 
gr. v. to x. 
gr. v. to x. 
gr. x. to xxx. 
gr. x. to xx. 
gr. iii. to xx. 
gr. xx. to xl. 
dr. ss. to i. 
gr. xx. to xxx. 
dr. ss. to i. 
gr. iii. to xxx. 
gr. v. to xx. 
dr. i. to viii. 
dr. i. to viii 
dr. ss. to oz. iss. 
dr. ss. to vi. 
dr. i. to viii. 
dr. ss. to ii. 
dr. ss. to oz. iss. 
dr. i. to iii. 
dr. i. to ii. 
aperient diet. 

gr. x. to lx. 

dr. ss. to i. 

decoct, water oz. ii. ) 

azedarach oz. iv. $ 

gr. xx. to lx. 

cochl. min. i. to iii. 

gr. x. to xl. 

dr. i. to iii. 

gr. xx. to xxx. 

gr. v. to xx. 

apply to the abdomen. 

gr. v. to xx. 

gr. x. to xx. 

gr. v. to x. 

m. i. to ii. 

f. dr. i. to oz. ss. 

gr. v. to xxx. 

gr. v. to xx. 

gr. x. to oz. i. 

dr. ss. to ii. 



dose f. 

ss. oz. 



gr. v. to xx. 



m. xx. to dr. i. 
f. dr. ss. to dr. i. 
gr. xx. to xxv. 
or. x. to dr. ii. 



APPENDIX. 



511 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED 



ORDER 4 ANTACIDS (CONTINUED.) 

Potassae subcarbonas, subcarbonate ofpotassa,. . 

Potassae carbonas, carbonate ofpotassa, 

Liq. potassae subcarbonatis, sol. ofcarb. potassa. 

Liq. potassae, solution ofpotassa, 

Creta praeparata, prepared chalk, 

Liquor calcis, lime water, 

Magnesia, 

Magnesia subcarbonas, carbonate of magnesia,. 

Sodas subcarbonas, carbonate of soda, 

Sodaa subcarbonas exsiccata, dried carb. soda, 

Sodee carbonas, carbonate of soda, 

Sodae snpercarbonas, 

ORDER 5— DEMULCENTS. 
Glycyrrhiza glabra, liquorice, 
Ulmus fulva, slippeiy elm bark. 
Acaciae gum. gum Jlrabic. 
Tragacantha, tragacanth, 
Lini usitatissimi semina, flax seed. 
Cydoniae semina, quince seeds. 
Cetaceum, spermaceti. 
Cera, wax. 

Althae officinalis, marshmallow. 
Amygdala, almonds. 
Amylum, starch. 
Avena sativa, the oat. , 
Hordeum, barley. 
Lichen islandicus, Iceland moss. 
Malva sylvestris, mallows. 
Uva passa, raisins. 
Caricae fmctus, jigs. 
Tussilago farfara, coltsfoot. 
Oleum olivae, olive oil. 

ORDER 6— ANTIDOTES. 
Albumen. 
Gallse, galls. 
Saccharum, sugar. 
Acida, acids. 

Omnes medicinae, i. e. all the articles of the 4th 
order. 



POSOLOGICAL. 

gr. x. to dr. ss. 
gr. x. to dr. ss. 
m. x. to dr. i. 
m. vii. to dr. ss. 
gr. x. to xl. 
f. oz. i. to vi. 
gr. x. to xxx. 
gr. xx to oz. i. 
gr. xx. to oz. ss. 
gr. iii. to vi. 
gr. x. to oz. ss. 
dr. ss. to i. 

The articles in Order 5 may 
be used in the form of Emul- 
sions, Ptisans, Solutions, &c. 



1 CLASS II. 

Medicines which act upon the glandular system, and upon 
the secretory and excretory vessels. 

Order 1st — Secretory Stimulants. Medicines which aet upon the 

whole glandular system. 
" 2d — Sialagogues. Medicines which increase the secretion of saliva. 
" 3d — Expectorants. Medicines which promote the secretion of 

mucus or pus from the bronchial tubes. 



512 APPENDIX. 



A SYNOPTICAL TABLE OF MATERIA MEDIC A— CONTINUED. 

Order 4th — Errhixes. Medicines which promote the secretion of mucus 
in the nostrils. 

" 5th — Diaphoretics. Medicines which excite cutaneous exhala- 
tion. 

" 6th — Diuretics. Medicines which increase the secretion of urine 
by exciting the action of the kidneys. 

" 7th — Emenagogues. Medicines which promote the secretion of 
menstrual discharge. 



EOSOLOGICAE. 

gr. ss. to iii. 
gr. i, h h, to L 

gr. i. to x. 
to be chewed. 



ORDER 1— SECRETORY STDIULANTS. 

Iodina, iodine, 

Hydrargyrum, mercury, 

ORDER 2— SIALAGOGUES. 

Daphne mezereum, mezereon, 

Anthemis yyTethram, pellitary root,. 

NicoLiana tabacum, tobacco, 

Mastiche, mastich, jgr. x. to xxx. 

Pillulae hydrargyri, blue bill, jgr. ii. to v. 

Unguentum hydrargyri, mercurial ointment, apply by friction, 

Hydrargyri oxymurias, corrosive sublimate,. . . . \gr. 1-16 to £. 

Hydrargyri submurias, calomel, .gr. h. to i. 

Hydrargyri nitrico oxydum, red precipitate, ;apply externally. 

Hydrargyrum prseciprtaturn album, white precip.l do. do. 
Hydrargyrum sulphuretum rubrum, cinnabar,. . gr. x. to xxx. 
Hydrargyrum sulphuretum nigrum, Ethiop's I 

mineral, gr. v. to xxx. 

ORDER 3— EXPECTORANTS. 

Asclepias tuberosa, 'gr. xx. to dr. i. 

Cetaceum, spermaceti, . jgr. xv. to dr. iss. 

Poly gala senega, seneka, gr. x. to dr. ss. 

Scilla maratima, squill, gr. iii. to x. 

Allium sativum, garlic, |dr..ss. to ii. 

Arum triphyllum, wake rebin, (Indian turnip,), gr. xii.to dr. i. 

Ammoniacum, ammoniac, gr. x. to xx. 

Assafoeetida, 'gr. v. to xx. 

Camphora, camphor, igr. ii. to x. 

Cabonas potass© et soda, carbonate of potassa 

and soda, gr. x. to xxx. 

Balsamum tolutanum, gr. x. to xxx. 

Balsamum peruvianum, baloam ofperu, jgr. x. to xxx. 

Glycyrrhiza glabra, liquorice root, decoction. 

Ipecacuanha, gr. i to ii. 

Lichen Islandicus, Iceland moss, gr. xx. to dr. i. 

Pix liquida. tar dr. ss. to i. 

Oleum olivae, olive oil dr. i. often repeated .. 

Antimonium, antimony, gr. 1-12 to 1-10. 

Mel, hoiiey. dr. i. repeated.. 

Omnia medicamenta Class 1, Ord. 5. All the 

Demulcents. 



APPENDIX 



113 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED. 



ORDER 4— ERRHINES. 

Helenum Autumnale, sneeze weed, (pultfd,) 
Nicotiana tabacum, tobacco, (snuff,) 
Asarum Europseum, asarabacca leaves. 
Helenium, elecampane. 
Veratrum Album, white hellebore. 
Hydrargyri sulphas flavus, turpeth mineral. 
ORDER 5— DIAPHORETICS, 

Dover's powder, 

Antimonium tartarizatum, emetic tartar, 

Ipecacuanha, 

Nitras potassae, salt pitre or nitre, 

Spiritus mindereri, acetate of ammonia, 

Eupatorium perfoliatum, thoroughwort, (infus.) 
Asclepias tuberosa, butterfly weed, oz. to quart, 
Guaicum officinale, guaicum wood and resin, . . 

Daphne mezereum, mezereon, (decoc.) 

Sarsaparilla, 

Lauras sassafras, sassafras, (tea or) 

Xanthoxylum fraxineum, prickley ash, (decoc.) . 

Saponaria officinalis, soapwort, (decoct.) 

Sulphur, 

Colchicum autumnale, meadow saffron, 

Tincture do 

ORDER 6— DIURETICS. 

Digitalis purpurea, fox glove, . . 

Scilla maratima, squill, . ., . . 

Colchicum autumnale, meadow saffron, 

Cantharis vesicatoria, Spanish flies, 

Copaifera officinalis, copaiba, 

Piper cubeba, cubebs, — * 

Apium petroselinum, parsly root, (infus.) . 
Daucus carota, garden carrot, (wild carrot seeds,) 
Solanum dulcamara, bittersweet, (decoct). . . 

Juniperus communis, juniper, 

Smilax sarsaparilla, sarsaparilla, 

Leontodon taraxacum, dandeleon, (decoct.) . 

Oleum terebinthinse, oil of turpentine, 

Ulmus fulva, slippery elm bark, 

Pix liquida, tar, *•***. 

Acidum aceticum, acetic acid, 

Acidum malicum, malic acid, 

Acidum nitricum dilutum, dilute nitric acid. 
Spiritus eetheris nitrici, sweet spirit? of nitre. 

Acetas potassae, acetate ofpotassa, 

Nitras potassae, nitre or saltpetre, 

Super-tartras potasa, - 

Sodas subcarbonas, subcarbonate of soda, . . 

Soda bicarbonas, bicarbonate of soda, 

Sapo medicinalis, medicinal soap, 

ORDER 7— EMENAGOGUES. 

Hydro Piper, (infusion,) 

Helleborus niger, black hellebore, 

33 



POSOLOGICAL. 



gr. v. to xv. 

gr. I to I. 

gr. £ to ii. 

gr. v. to x. 

f. oz. ss. to iss. 

f. dr. L oz. iss. to to 1 quart. 

tea cup full every two hours. 

gr. x. to xxx. 

h gill four times daily. 

dr. ss. to i. 

gr. xx. to dr. i. 

gr. xx.to dr. i. or 2 pints pr day 

oc. ii. in 24 hours. 

gr. xx. to dr. ii. 

gr. i. to v. 

dr. ss. to i. to ii. 



gr. ss. to in. 
gr. i. to iii. 
gr. i. to v. 
gr. i. to ii. 
m. xv. to xxx. 
dr. ss. to iss. 



f. oz. ii. 4 times daily. 

dr. i. to ii. 

gr. xx. to dr. i. 

f. oz. i. to iss. 

m. x..to dr. ss. to i. 

gr. xx. to dr. i. 

dr. ss. to i. 

f. dr. ss. to ii. 

f. dr. i. to ii. 

m. x. to xl. 

f. dr. ss. to i. 

gr.. xx. to dr. L 

gr. v. to xx. 

gr. xx. to dr. ii. 

gr. x.'to dr. ss. 

gr. xx. to dr. i. 

or. v. to xx. 



dr. i. to ii. per diem, 
2T. x. to xx. 



14 APPENDIX. 



A SYNOPTICAL TABLE OF MATERIA MEDIC A- CONTENTED. 

ORDER 7 — EMEXEGOGUES. CO>TI>XED.) POSOLOGICAL. 

Juniperus sabina, savine, gr. xv. to xx. 

Mentha pulegiurn, European pennyroyal, (infu.j ad lib. 

Rubia tinctoriura, madder, gr. x. to dr. ss. 

Rosmarinus officinalis, rose/nary, make a tea. 

Poly gala senega, senega, gr. x. to dr. ss. 

Cantharis vesicatoria, Spanish, fixes, gr. ss. to i. 

Aloes extractum, extract of aloes. gr. v. to xv. 

Assafcetida, gr. v. to xx. 

Ruta graveolens, rue, gr. xx to xL 

Myrrha, myrrh, gr. x. to xx. 

Galbanum, gr. v. to xv. 

Sagapenum, »•• gr. x. toxx. 



CLASS III. « 

Medicines which act upon the heart and arteries. 

Order 1st — Sedati>t:s. Medicines which diminish the power and velo- 
locity of the circulation, by their operation on the heart and 
large arteries. 
'2d — Refrigerants. Medicines which diminish the heat of the 

body, by their action on the extreme vessels. 
3d — Tomcs. Medicines which invigorate the circulation and thus 
relieve debility or atony. 
" 4th — Arterial Stimulants. Medicines which excite the circu- 
lation. 



ORDER 1— SEDATIVES. 




Laurus camphora, camphor laurel, 


gr. u. to x. 


Colchicum autumnale, meadow saffron, 


gr. i. to v. 


Conium maculatum, hemlock, 


gr. ui. to v. 


Acidum hvdrocianicum, Prussia acid, (dilute.). 


m. i. to 7. cautiously. 


Antimonium tatarizatum, emetic tartar 


gr. 1-16 to 1-12 


Veratrum album, ichite hellebore 


gr. L to ii. 


Humulus lupulus, hops, 


gr. vi. to xiL to dr. ss. 


Digitalis purpurea, foxglove, 


gr. l.to m. 


Plumb i acetas. acetate of lead 


gr. ss. to n. to uj. 


Potassae nitras. nitre or saltpetre 


ctt. V. tO XX. 


ORDER 2— REFRIGERANTS. 




Aqua frisida. cold water. 




Acidum acetic urn. acetic acid. 




Acidum citricum, cetric acid. 




Acidum tartaricum, tartaric acid. 




Potassae sales, salts ofpotassa. 




E pi umbo preparata. preparations of lead. 




E zinco preparata, preparation of zinc. 





APPENDIX. 



515 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED. 



ORDER 3— TONICS. 
Cinchona, 

Aristolochia serpentaria, Virginia snakeroot, . . 

Primus Virginiana, wild cherry bark, 

Cornus Florida, dog-wood, 

Chironia angularis, American centaury, 

Liriodendron tulipifera, tulip tree bark, 

Bonplandia trifoliata, angustura bark, 

Cocculus palmatus, columba, 

Gentiana lutea, gentian, 

Quassia excelsa, quassia, 

Quassia simaruba, simaruba, 

Croton Eleutheria, cascarilla, 

Anthemis nobillis, chamomile, 

Humulus lupus, hops, 

Aurantii cortex, orange peel, 

Acorus calamus, sweet flag, 

Artemisia absinthium, wormseed, 

Krameria, rhatany, 

Nux vomica, 

Marrubium vulgare, horehound, 

Menyanthes trifoliata, buck bearh, 

Myrrha, myrrh, '. 

Salix alba, white willow, 

Bismuthi subnitras, white oxide ofbixmnth, 

Nitras argenti, nitrate of silver, 

Oxydum zinci, oxide of zinc, , 

Ferrum, iron, (different preparations of.) 

Cuprum, copper. 

ORDER 4— ARTERIAL STIMULANTS. 

Cantharis vesicatoria, Spanish flies, 

Oleum terebinthinae, oil of turpentine, 

Phosphorus. 
Alcohol. 



POSOLOGICAL. 

gr. viii. to xx. to dr. i. 

gr. x. to xxx. 

dr. ss. to i. 

gr. xx. to dr. i. 

dr. ss. to i. 

dr. ss. to i. 

gr. x. to xxx. 

gr. x. to xxx. 

gr. x. to dr. i. 

gr. xx. to dr. i. 

gr. xx. to dr. i. 

gr. x. to xxx. 

dr. ss. to i. 

fr. vi. to xii. 

dr. ss. to i. 

gr. xx. to dr. i. 

gr. xx. to xl. 

gr. xx. to dr. i. 

gr. & to i. to iii. 

gr. xx. to dr. i. 

gr. xx. to dr. i. 

gr. x. to xx. 

gr. ii. to viii. 

gr. v. to x. 

gr. ss. to ii. 

gr. l. tov. 



, 



sicum annuum, cayenne pepper, 

Caryophillus aromaticus, cloves, 

Zinziber, ginger, 

Pimpinella anisum, anise, 

Acorus calamus, sweet flag, 

Cochlearia armoracia, horse raddish, 

Balsamum peruvianum, balsam ofperu, 

Carui semina, caraway seed, ■ 

Resina rlava, resin, 

Balsamum tolutanum, balsam oftoulou, 

Oleum cajuputi, cajuput oil, 

Canella alba, canella, 

Cardamomum, cardamon, 

Laruus cinnamomum, cinamon, (bark,) 

Oopaiba, balsam of copaiva, ••••'• 

Coriandrum sativum, coriander, 

Piper cubeba, cubebs, 

Cuminum, cumin (seed,) 

Anethum foeniculum, fennel seed, 



gr. ss. to i. 
dr. ss. to ii. 



gr. v. to x. 
gr. v. to xx. 
gr. x. to xx. 
gr. xv. to dr. i. 
gr. xx. to dr. i, 
dr. i. to ii. 
gr. x. to dr. ss. 
gr. xx. to dr. i. 



gr. x. to dr. ss. 
m. v. to m. x. 
gr. x. to dr. ss. 
gr. v. to xx. 
gr. v. to xx. 
m. xx. to lx. 
gr. xx. to dr. i. 
dr. i. to iii. 
gr. xx. to dr. i. 
gr. xx. to dr. s 



516 



APPENDIX. 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED* 



ORDER 4 ARTERIAL STIULANTS, (cONEIn'd,) 

Giacum. gum, 

Lavandula, lavender, (oil of,) 

Mastiche, mastich, ( 

Mentha piperita, peppermint, (infus.) 

Mezereum, mezereon, , 

Myristica, nutmeg, 

Olibanum, 

Pimenta, pimento, 

Pix liquida, tar, . 

Anthemis pyrethrum, pellitary root, 

Sabinus, savine, . 

Serpentaria, Virginia snake root, 

Styrax officinate, storax, . 

Sinapis, mustard, 

Mther sulphuricus, sulphuric ether, 

Vinum, wine, 

Aqua chlorinii, chlorine water, 

Calcx chlorinata. 
Soda chlorinata. 
Ferrum, iron. 
Petroleum. 

Naptha, 

Piper longum, long pepper, 

Piper nigrum, black pepper, 



POSOLOGICAL. 

gr. x. to dr. ss. 
m. i. to m. v. 
gr. x. to dr. ss. 
ad libitum, 
gr. i. to x. 
gr. v. to xx. 
gr. x. to xx. 
gr. v. to xx. 
dr. ss. to i. 
to be chewed, 
gr. v. to xv. 
gr. x. to dr. ss. 
gr. x. to xv. 
dr. iv. 

dr. ss. L to ii. 
dr. i. to oz. ii. 
dr. i. to ii. 



mr. xxx. to lx. 
gr. v. to xx. 
gr. v. to xx. 



CLASS IV. 

MeJicines which act on the brain and nervous system. 

Order 1st — Narcotics. Medicines operating on the brain and nerves 

diminishing sensibility and inducing sleep. 
" 2d— Antispasmodics. Medicines operating on the nervous system 

and allaying inordinate muscular action. 
" 3d — Nervous Stimulants. Medicines which excite the brain and 

nervous system, and thereby increase their irritability and 

energy. 

ORDER 1— NARCOTICS. i 

Opium, gr. i. ii. to vi. 

Lactuca sativa, lettuce, ab. lib. 

Camphora, camphor, 'gr. ii. to xx. 

Humulus lupulus, hops, (in the form of extract,) gr. x. to scr. ii. 

Hyoscyamus, henbane, gr. i to ii. 

Conium maculatum, hemlock, ;gr. iii. to v. 

Atropa belladona, deadly night shade, gr. £ to v. 

Datura stramonium, thorn apple, ! gr. ii. to iii. 

Anonitum, anonite, Igr. i. to v. 

Solanum Dulcamara, bitter sweet, .dr. ss. to i. 

Digitalis purpurea, fozglo ve, . . 'gr. i. to iii. 



APPENDIX. 



517 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED. 

ORDER 1 NARCOTICS, (CONTINUED.) POSOLOGICAL. 

Nicotiana tabacum, tobacco, 

Strychnos, Nux vomica, (rasped,) 'gr. i. to iii. 

Acidum Uydrocyamcum, prussic acid, (diluted,) ji». i. toiv. 
Lauras nobilis, bay tree. 

Morphia, . . 

Narcotin. 

ORDER 2— ANTISPASMODICS. 

Assafoeetida, 

Castoreum, castor, Igr. x. to xx. 

Galbanum, . Igr. v. to xv. 

Gum ammoniac um, gum ammoniac, gr. x. to xx. 

Moschos moschiferus, musk, Igr. ii. to xx. 

Valeriana officinalis, valerian, ! gr. xx. to dr. i. 

Draconitum, skunk cabbage, gr. x. to xx. 



gr. h h to f. 



gr. x. to xv. 



jEther sulphuricus, sulphuric ether, 

Oleum succini, oil of amber, 

Belladona, deadly night shade, 

Camphora, camphor, 

Hyoscyamus, henbane, , 

Sagapenum , 

Opium, ■....■ , 

Datura Stramonium, thorn apple, , 

Conium maculatum, hemlock, 

Ipecacuanha radix, ipecacuanha root, 

Cuprum ammoniatum, ammoniated copper, 

Nitras argenti, nitrate of silver, , 

Zinci oxydum, oxyde of zinc, , 

Zinci sulphas 

ORDER 5— NERVOUS STIMULANTS. 

Ammonia, , 

Allium porrum, leek (juice,) , 

Allium sativum, garlic, , 

Strychnia Nux Vomica, (rasped,) , 

Opopanax, 

Secale cornutum, spurred rye, ergot, , 

Anethum graveolens, dill, 

Assafcetida, 

Galbanum, 

Valeriana officinalis, valerian, 

Rhus toxicodendron, poison oak, 

iEther sulphuricus, sulphuric ether, 

Sagapenum, 



dr. ss. to ii. 
m. v. to xv. 
gr. ss. to v. 
gr. ii. to xx. 
gr. iii. to x. 
gr. x. to xx. 
gr. ss. to iii. 
gr. ii to iii. 
gr. ii. to x. 

gr. ss. to iii. 
gr. ss. to iv. to vi. 
gr. i. to v. 
gr. i. to iii. 

gr. x. to dr. ss. 
dr. ss. to i. 
dr. ss. to ii. 
gr. i. to v. 
gr. x. to xxx. 
gr. xv. to xx. 
gr. xv. to dr. i. 
gr. x. to xx. 
gr. v. to xv. 
gr. xx. to dr. i. 
gr. ii. to iv. 
dr. ss. to ii. 
gr. x. to xx. 



CLASS V. 

Medicines which act on the muscular fibres. 



Order 1st — Astringents. Medicines which, by inducing contraction oi 
the muscular fibre, restrain inordinate evacuations and 
haemorrhage. 



518 



APPENDIX. 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED. 



ORDER 4— ASTRINGENTS. 

Querius et Gallee, oak bark and galls, 

Geranium malculatum, crane's bill, 

Hasmatoxylon Campeachianum, logwoood, (deco, 

Kino, 

Catechu, ,. 

Krameria triandra, rhatany, (decoc.) 

Rosa Gallica, red roses, 

Salix alba, white willow, 

Tormentilla erecta, tormentil, 

Uva ursi, 

Alumen, alum,. 



POSOLOGICAL. 

gr. x. to xx. 
dr. i. to iss. 
oz. ii. to iii. 
gr. x. to dr. i. 
gr. x. to xx. 
oz. i. to ii. 



gr. x. to xx. 
gr. xx to dr. ss. 
gr. x. to dr. ss. 
.Igr. v. to xx. 



Acidum sulphuricum, sulphuric acid. ( diluted,). jm. x. to xl. 

Acctas plumbi, acetate of lead, gr. ss. to iii. 

Sulphas zinci, sulphate of zinc, gr. i. to iii. 



CLASS VI. 

Medicines which act upon the skin and external parts, by- 
application to the surface of the body. 

Order 1st — Epispastics. Medicines which excite external irritation. 

" 2d — Emollients. Medicines which allay external irritations by 
softening the skin. 

Note. — All medicines externally applied (except those which belong to 
Class vi.) may be considered as stimulant, tonic, sedative, &c. and are there- 
fore arranged in their respective orders. 

ORDER 1— EPISPASTICS. 

Nitras argenti, nitrate of silver. 

Catharis vesicatoria, Spanish fiks. 

Ammonia. 

Granville's lotion. 

Allium sativum, garlic, 

Euphorbia ipecacuanha, American ipecacuanha, 

Elemi. 

Potassa fusa. 

Acida, acids. 

Pix Burgundica, burgundy pitch. 

Sabina, savine. 

Sinapis, mustard. 

Antimonium, antimony, with lard, dr. i. to oz. i. 

Iodina, iodine. 

Potassa cum calce, potassa with lime. 

ORDER 2— EMOLLIENTS. 
Cetaceum, spermaceti, 
Oleum olivse, olive oil, 
Sevum, suet. 
Aqua calida. 
Adeps, lard. 



APPENDIX. 



519 



A SYNOPTICAL TABLE OF MATERIA MEDICA— CONTINUED. 



TINCTURES. 

Tinctura aloes, 

" alois compositae, , 



" aurantii, orange peel, 

" camphorse compositae, 

" cantharidis, Spanish flies,... 

" capsici, red pepper, 

" castorei, 

" digitalis, fox glove, 

" ferri ammoniati, 

" ferri muriatis, 

" guaiaci ammoniatae, 

" hurnuli, hops, , 

" iodini, 

" kino, 

" rhei compositae, 

" Valerianae, 

" lobeliae, Indian tobacco, 

" camphorae, 

" seminum colchici, seeds of mead, saffron 

" stramonii, thorn apple, , 

" sanguinariae, bloodroot, 

SYRUPS. 

Syrupusscillae, squill, , 

" phytolaccae decandrae, poke root, 

'• aurantiorum, orange peel, 

" papaveris, poppies, 

" rosearum, roses, 

11 rosearum gallicarum, red roses, 

" limonis, lemon, 



POSOLOGICAL. 
1. to ii. 
i. to ii. 
i. to ii. 
i. to ii. 
i. to ii. 
x. to dr.i. 
x. to dr. i. 
i. to ii. 
x. to dr. ss. 
ss. to ii. 
v. to dr. ss. 
ss. to ii. 
ss. to ii. 
x. m. xl. 
i. to ii. 
i. to oz. ss. 
i. to ii. 
i. to ii. 
v. to dr. i. 
x. to Ix. 
x. to xx. 
xxx. to lx. 



1. to 1SS. 
i. to ii. 



ss. to oz. 1. 
ii. to oz. ii. 



dr. i. to ii. 



DESCENT, PROCIDENTIA, RETROVERSION, 



AND 



PROLAPSUS UTERI. 



The vagina, or canal that leads to the uterus, is so con- 
structed, that its posterior portion, which lies in contact with 
the rectum, and which may be considered its lower surface, 
if measured from the commissure upwards and around for- 
ward to the upper side of the neck, is about three inches lon- 
ger than its anterior portion, or upper surface, which lies in 
contact with the bladder. Its upper surface is attached to 
the bladder, by peritonaeal, and to the urethra by cellular con- 
nections; and its lower surface is attached to the rectum, al- 
so by cellular connection, till it reaches to the reflection of 
the peritonaeum. 

The uterus is so situated as to have the bladder before, 
and the rectum behind it, with both of which it is connected 
by a reflection of the peritonaeum. Its shape resembles that 
of a pear, but flattened, more particularly so on its anterior 
side. 

Its small extremity, or neck, is not a continuation of the 
same line with the vagina. It is projected into the anterior 
side of that canal, in the greater number of subjects, about an 
inch nearer to the os externum, than the angle or upper ex- 
tremity of the sac which terminates the canal. Hence the 



APPENDIX. 521 



reflection of the posterior portion of the vagina, as it turns 
from the rectum upwards and forwards to meet the anterior 
portion, and form a junction round the neck, produces a cul- 
de-sac at the upper extremity, above and behind the os uturi. 

Writers have divided the uterus into three parts : the fun- 
dus, the body, and the neck. The fundus includes all that 
part of the organ, which is above a line passing across the 
origin of the fallopian tubes. 

The body includes the portion below that line, down to 
the commencement of the neck. 

The neck is the portion which dips into the vegina, and 
terminates in the os tincae. 

The peritonaeum passing downwards from the inner side 
of the abdomen, covers the fundus of the bladder and de- 
scending till it meets the body of the uterus, turns upwards 
and covers its anterior side, making a pocket between the 
bladder and uterus ; then passing over and making a cover- 
ing for the fundus, it descends, covering the body till it reach- 
es the rectum, &c. making another and a deeper pocket be- 
hind the uterus, between it and the rectum. In forming these 
pockets, the peritonaeum makes two folds on each side of the 
uterus, which being extended laterally, connects them to the 
sides of the pelvis, constituting the broad ligaments, each of 
which has an anterior and a posterior portion. The anterior 
portion includes the fallopian tubes, the posterior, the ovaria. 

The round ligaments originate, one on each of the sides of 
the uterus, and passing along in the doublings of the broad 
ligaments, rise to the brim of the pelvis, and turn over it, 
through the abdominal rings. 

The broad and round ligaments 'aid in supporting the 
uterus in its proper position, but the vagina, sustained as it 
is, by its connections with the rectum and bladder, is its 
main support. 

The fundus with the broad and round ligaments, together 
with the two pockets above described, constitute the floor on 



522 APPENDIX. 



which the lower intestines rest ; and in course are liable to 
be pressed downwards by lifting heavy weights or by the 
pressure made by the muscles of the abdomen when the bow- 
els are in a state of constipation. 

If the uterus should sink from its natural position in the 
brim, into the cavity of the pelvis, which change is termed a 
descent, it must put its ligaments on the stretch, and drag the 
rectum and bladder, more or less inconveniently, according 
to the degree of descent. 

If the descent take a direction, so that the uterus shall slide 
down into the vagina, we have the second stage of displace- 
ment, a tendency towards a prolapsus, which is called a pro- 
cidentia. In this condition of things, we have a greater dis- 
tension of the ligaments, as well as an increased tendency of 
the vagina, rectum and bladder, to descend with the uterus, 
until at length it may protrude beyond the vulva, which con- 
stitutes the third stage, and which is strictly a prolapsus 
uteri. 

Those of the sex who have large pelves; those who are 
of relaxed habit ; those who haveJborne many children ; and 
those advanced in years, are more liable than others to the 
inconvenience under consideration. But it is not confined to 
these alone, it may befal the aged matron or the youthful 
virgin. Doctor William Campbell of Edinburg, encounter- 
ed complete protrusion in a female of twenty-one, who had 
labored under it for more than two years previously ; and 
Capuron relates an instance of prolapsus in a girl of fourteen. 
Doctor Dewees met with a number of instances of the same 
kind, which befel unmarried females ; and the writer of this 
essay has been consulted by fifteen, or perhaps twenty, in 
the course of his practice. 

In the first stage, the stretching of the ligaments, and drag- 
ging of the connections which fasten the uterus to the rec- 
tum and bladder, produce pain in the loins, which in conse- 
quence of the sympathies of the connecting structures, often 



APPENDIX. 523 



extend along the sacrum and coccyx, sometimes accompani- 
ed by a knawing or dragging sensation in the groins, and an 
inability to continue for any length of time in the erect pos- 
ture. All these inconveniences are often considered by the 
patient to be the effect of debility or rheumatism. Some ca- 
ses however, are less liable to such misapprehension, being 
attended by an increase of menstrual secretion, or by a leu- 
chorrhoeal discharge, more or less profuse. 

Any additional inconveniences which may occur as the 
case progresses into the condition which is termed the second 
stage — such as difficulty in discharging faeces and urine, or 
even entire disability until the uterus is elevated by the fin- 
ger — tenesmus ; disuria ; an increase of leuchorrhoeal dis- 
charge ; are all referrible to the altered situation of the womb 
— the dragging which it exerts on the organs to which it is 
connected, and the lateral pressure which its descent mtist 
inevitably make on the circumambient structures. A sum- 
mary of the symptoms may be acceptable. 

An unusual weight in the pelvis, and a dragging sensation 
in the iliac regions, which are aggravated by the erect pos- 
ture ; a bearing down resembling tenesmus ; pain in the back, 
accompanied by a peculiar appearance in the patient's walk, 
as if her lower extremities were exceedingly weak ; a be- 
numbing sensation shooting down the thighs, especially 
when she first rises on her feet, or when she attempts to re- 
cline — sometimes she will support herself in a leaning pos-, 
ture, resting her hands on her knees ; a discharge of a mate- 
rial of a muco-purulent appearance from the vegina, which 
is sometimes tinged with blood, and in some instances gives 
out an offensive odor — the menstrual discharge is in some 
instancess too abundant, and recurs too frequently ; in others 
during the interval of the menses, there is a constant leu- 
chorrhoea. 

When these symptoms shall become established, on ex- 
amination, the uterus will be felt nearer the external part 



524 APPENDIX. 



than usual, or its neck will be projected slightly from the 
vagina. From this time, every function which requires 
much action of the diaphragm or other abdominal muscles, 
will serve progressively to advance the uterus towards the os 
externum, until a considerable portion or the whole of it be 
at last pushed extra vulvam, which constitutes the third stage. 

Clear and satisfactory as this description of the disease may 
seem to be, an examination per vaginam and per rectum 
ought always to be insisted on before giving a prescription. 
This done, and the true state of things having been ascer- 
tained, the condition of the system in regard of general 
health, is to be considered and treated according to existing 
circumstances. As far as practicable, the true pathology of 
the case should be known. Inflammatory action should be 
subdued by means of depletion, general or topical, or both, 
as # there may be occasion, and by the use of the bath. Irri- 
tation should be soothed and retired, and any visceral disease 
should be treated with a proper regard to the organ affected. 
But as the management shall have respect to the prolapsed 
uterus, the principal intention should be to replace, and then 
by means of a suitable instrument, to sustain it, in situ, until 
the relaxations shall be corrected and the natural tone of the 
ligaments, vagina, rectum, bladder and their peritonaea! con- 
nections, shall be recovered. 

In treating a case of procidentia, much may be done by 
.posture. Sir Charles Mansfield Clark says, the patient should 
be as much as possible upon a bed, or upon a sofa ; but con- 
siders a mattress better than either. Strong action of the 
abdominal muscles must be guarded against, and the diet of 
the patient should be sufficiently nutritious, but the stomach 
and bowels should never be loaded. The bladder should 
not be suffered to contain a large quantity of urine, and all 
articles of food or drink known to produce flatulency ought 
to be avoided. 

A pessary of proper shape and dimensions affords the most 

I 



APPENDIX. 525 



effectual support for the uterus, when that sort of aid is re- 
quired. The flat concave circular instrument, recommended 
by Dr. Dewees, has afforded comfort in many instances, and 
sometimes permanent relief. If, however, it is large enough 
to prevent its escape, it must produce too much lateral or cir- 
cumferential distension. It makes a bed on which the ute- 
rus may recline, but it is too much below its natural position 
to relieve the ligaments, and afford them good opportunity 
to recover their natural tone and retract to their proper 
length : besides the lateral or circumferential expansion 
which the instrument will produce, must hinder the vagina 
from recovering its longitudinal distension, without which 
complete recovery must be impracticable. 

The spherical or globular pessary is better, inasmuch as it 
must produce more longitudinal distension of the vagina, of 
course, more elevation of the uterus * relieving the tension of 
the ligaments and lessening the dragging of the rectum and 
bladder. The utility of a pessary of this description was 
known to Hippocrates, who employed a pomegranate of 
suitable dimension, first steeping it in wine. 

Dr. Charles M. Clark says, " a good pessary should com- 
bine firmness, lightness and closeness of texture : firmness, 
that it may not yield to pressure ; lightness, that it may not 
incommode by weight ; and closeness of texture, that it may 
not imbibe the secretions of the vagina." 

" Pessaries are made of various shapes as well as of differ- 
ent materials, adapted to different cases and circumstances. 
For a majority of cases a circular or oval pessary answers 
sufficiently well ; but the circular pessary can be used, in 
those cases only, where the disease has not made great pro- 
gress, and where the tone of the vagina is not much im- 
paired ; if the vagina has been much dilated, no pessary of 
small size can be sustained in it ; and one of a larger size, 
of a circular form, might do mischief by compressing the 



526 APPENDIX. 



urethra and rectum, and so preventing the discharge of the 
faeces and urine." 

The inconveniences and injuries which have been pro- 
duced by the various kinds of pessaries have been such, that 
their usefulness is held to be doubtful by some physicians of 
great pretensions; indeed, the remedy has been considered 
as altogether injurious. An instrument of proper construc- 
tion, it is hoped, will rectify all these evils. 

If we duly consider the anatomy of the organ to be sup- 
ported by a pessary, we cannot fail to perceive, that the in- 
strument, if it shall have good pretension to a philosophical 
adaptation, ought to fill the cavity of the vagina Without in- 
convenient distension, either lateral or longitudinal. It 
should reach about four inches above the os externum, and 
should have a neck, by which the entire weight of the organ 
and instrument, may be made to rest upon a bandage or 
cushion fitted for that purpose. Its upper extremity should 
occupy the cul-de-sac. lifting it above the neck, and present 
a suitable cavity on its anterior side, into which it shall re- 
ceive the neck of the womb. This last named adjustment, 
will secure to the uterus the necessary elevation, and to the 
fundus of the organ an inclination in conformity to its natu- 
ral angle with the vagina ; and the neck when received into 
the eavity will subserve to keep the instrument in its proper 
position. 

On the anterior side of the instrument there should be a 
sulcus or groove of sufficient capacity to protect the urethra. 
This groove will also enable the patient at any time, very 
conveniently, with the end of the fore finger, to ascertain 
whether the instrument retains its intended position : and it 
will make a channel for the exit of the secretions. 

To the small end, there should be attached a neck or stem. 
about an inch and a half in length, having at its lower ex- 
tremity, two circular buttons, seven-eighths of an inch in 
diameter, and one-fourth of an inch apart, for the purpose of 



APPENDIX. 527 



receiving and holding the bandage which is intended to sus- 
tain its weight. 

Preparatory to the successful employment of this pessary, 
it should be ascertained, that the vagina is in a condition for 
admitting the longitudinal distension necessary for its recep- 
tion ; which will not be the case, if the uterus and its liga- 
ments are bound down too low, by unnatural adhesions, or 
contractions. 

When the womb is in its natural position, its fundus in- 
clines a little forwards and its neck a little backwards. But 
when it begins to sink down towards the perinaeum, its in- 
clination is often retroverted, so that it is made to bear hard 
on the rectum, and the irritation produced by the misplace- 
ment, sooner or later sets up a sub-acute inflammatory con- 
dition of the parts involved, which is followed by adhesions 
more or less extensive or obstinate, corresponding to the de- 
gree of previous irritation and the time of its continuance. 

When such adhesions of the peritonaeal coverings of the 
uterus and ligaments, with those of the rectum and circum- 
jacent parts have become established, the contractions present 
to the finger when examined per rectum, the resemblances of 
tumors of various figure and dimensions. In cases of this 
kind the entire attachments must be broken up, and the ute- 
rus with its ligaments made to swing freely forwards to their 
natural position. Sometimes the contractions are found to 
be greater in the posterior surface and its connections with 
the rectum. In some instances the broad ligaments are 
dragged down and adhere to the posterior and lateral peri- 
tonaeal surfaces upon which they ought merely to slide. And 
in others, the anterior surface between the os externum and 
the neck is greatly contracted. All these points should be 
considered, and if either or all of them be found to exist, 
suitable manipulation must be applied and repeated as there 
may be occasion, till the correction shall be complete. 
Without this important preparation of the parts, all attempts 



528 APPENDIX. 



to maintain the uterus in situ, will be unavailing ; and in 
such instances, it requires a good deal of tact, to separate the 
adhesions and elevate the organ properly. One of the lead- 
ing objects in preparing this essay is, to embolden the profes- 
sion in performing an operation which may prove to be of 
vast importance to thousands. Many cases will be found, in 
which, although the state of things may seem forbidding, 
yet by firm and patient perseverance, the morbid condition 
may be overcome, and perfect and permanent relief be af- 
forded. 

About twenty-five years ago, we visited a patient in great 
distress. Her symptoms were such as commonly attend pro- 
lapsus uteri, but her greatest inconvenience, was an almost 
total inability to discharge her faeces or urine. On examina- 
tion per vaginam and per rectum, we found the uterus lying 
with its fundus nearly at one extremity of the long diameter 
of the pelvis, and the neck at the other ; a lateral displace- 
ment ; the uterus enlarged to a triple size, and so rigidly 
bound down to the circumambient structures, as not to admit 
of the least elevation without great force. Our first impres- 
sion was, that the case was incorrigible, and we were about 
to abandon it. Considering, however, that the enlargement 
of the organ and its adhesions might be the effect of dis- 
placement, merely; — an inflammatory tumefaction ; which 
was confirmed by the fact, that it was very sore to the touch, 
wcconcluded that an attempt to elevate it might be safely 
conducted, if not done too hastily, and if any new irritation 
which might be produced by the attempt, should be met with 
decision and careful treatment. With this conclusion, we 
proceeded at once to use our customary manipulations, per 
rectum, being very careful always to apply the finger late- 
rally, and not point foremost. Beginning with a moderate 
degree of pressure, and gradually increasing the force, on the 
right, on the left, and on the middle of the tumid uterus, as 
we could effect more room or find access for the finger : all 



APPENDIX. 529 



the while attending carefully to the complaints of our pa- 
tient. This first attempt satisfied us that the adhesions 
might be made to yield, and also, that too much must not be 
attempted at one sitting. So soon, therefore, as the patient 
earnestly desired respite, the operation was discontinued for 
that time. A gentle aperient of castor oil was administered, 
and repeated the following morning. In the course of thir- 
ty-six hours there was an occurrence of fever with tense 
pulse. She was bled sixteen ounces from the arm, which 
was succeeded that night by a dose of calomel, ten grains, 
with opium, two grains. The following day she was kept 
quiet in bed, and mild aperient and cooling remedies 
were used. On the fourth day, another and somewhat 
bolder attempt at elevation was made. This in like manner 
excited some irritation, making further depletion necessary. 
One moderate blood-letting and a gentle cathartic once or 
twice repeated, again tranquilized the system; after which, 
we continued to operate about twice a week. After ten or 
twelve sittings we succeeded in releasing the uterus from its 
unnatural attachments, and replaced it, in situ. By contin- 
ued attention ; a few times leeching the os tincee ; frequent 
blood-letting from the arm ; frequent small doses of calomel 
and ipecac, and when necessary, hyosciamus, or opium, or 
both, in order to allay existing irritation, and secure rest at 
night ; after eighteen months or two years, this patient was 
cured. 

In this case and in all others that we have treated, the 
pessary was not introduced, until a liberation and elevation of 
the uterus, and a retirement of existing irritation, had been 
accomplished. 

We have given this, the most difficult and forbidding in 
its appearance, of all the cases that have fallen under our ob- 
servation which admitted of cure, and feel great solicitude 
that it may meet a kind and candid reception ; because a 

34 



530 APPENDIX. 



majority of the cases which we have treated for uterine af- 
fections, have been such as labored under a descent and retro- 
version of the organ. - Prolapsus uteri appears to have been 
sufficiently well understood and denned by our writers on 
that subject. But the obstinate case here submitted, was not 
a prolapsus. The neck of the uterus had not slid down into 
the vagina. The uterus had descended, and its ligaments 
and connections with the vagina, rectum, and bladder, hav- 
ing become relaxed, it continued its descent, dragging after 
it the circumambient structures, till it had assumed a lateral 
displacement. 

After having met this case, we became more circumspect 
m our investigations, and have learned, that there are many 
instances, such as a physician on an ordinary and hasty ex- 
amination per vaginam might consider to be well enough, 
and which on a more careful investigation made per vaginam 
and per rectum, he will find to be retroversion and adhesion, 
requiring the most careful and skillful attention and manage- 
ment. This state of things may be present and an examina- 
tion per vaginam give very little inconvenience to the patient ; 
when at the same time, a slight degree of pressure made upon 
the uterus with the finger per rectum, will give great pain. 
It is a fact, however, that in such instances, when the opera- 
tion necessary for correction shall have been repeated, at each 
subsequent repetition, the patient will make less complaint, 
and at length, as the morbid attachments are broken up. she 
will experience but little inconvenience when the womb is 
elevated. 

The many trials which we have made of the flat circular 
pessary, of the oval and of the spherical pessaries, and the 
repeated disappointments which we met in the use of them, 
impelled us to try a three and a half inch tubular one, made 
of gum elastic, which answered better. But it would be- 
come too soft by the warmth and moisture of the vagina. 
Afterwards we had them made of wood, which answered 



APPENDIX. 531 



better, as it respected the necessary firmness ; bat there was 
a good deal of difficulty in retaining any of them in their 
proper position. This last mentioned inconvenience led to 
the conclusion, that the instrument should make considerable 
longitudinal distension, and to produce its full effect, must 
occupy the cul-de-sac, and by means of a suitable cavity on 
the anterior side, receive the neck, which with little trouble 
and attention would not fail to answer the intended purpose. 
In this shape we have so far proved its efficacy, that we are 
obliged to believe it will correct any condition of prolapsus, 
if it be properly used — we mean, if the medical treatment 
required in the case be judicious, and the instrument be 
rightly fitted, as to its length and size, including its cavity. 
Indeed, we entertain a hope, that it will supercede the neces- 
sity of a recourse to the surgical operation of Messrs. Marshall 
Hall, Heming and Ireland, — meritorious as it is said to be, in 
the hands of those distinguished gentlemen. 

The introduction of a pessary requires care. Having 
smeared the body and stem of the pessary with some unc- 
tuous substance, it should be passed in upon its side, and its 
upper end slid against the rectum with its stem inclined to- 
wards the pubis, until it shall be resisted by the cul-de-sac. 
Then turning it on its back, it cannot fail to receive the neck 
of the womb into its cavity. The patient should previously 
be furnished with a broad laced bandage to fit her lips with 
greater or less tightness, to suit her feelings. A convenient 
strap, with a button-hole or two in the middle, suited to the 
stem of the pessary, is then to be buttoned on it, and the end 
of the strap attached by a button or buckle to the bandage 
behind, drawing the stem backwards, so as to make pressure 
on the perinaeum. This last measure makes the neck and 
back part of the instrument act on the perinasum and rectum, 
which serve as a fulcrum ; and the upper end as a lever 
causes the uterus to swing forward to its place. The ante- 
rior end of the strap should be drawn up by another buckle 



532 APPENDIX. 



fastened to the waistband, above the pubis, with sufficient 
tightness to sustain the weight of the uterus. 

The attention of the patient should be called to all these 
particulars, and she should be instructed in them all, and 
have privilege to regulate them at discretion ; save only that 
she should be very careful that the instrument be introduced 
to its full length, every time it is applied, and always made 
to bear more or less against the perinaeum. She should also 
be made to understand, particularly, that if the instrument be 
not admitted to its full length, it had better be laid aside till 
the arrival of her physician j since the impracticability of its 
admission affords evidence, that the uterus is retroverted and 
needs the introduction of the finger per rectum, to throw, it 
forward to its place ; or that some adhesion is remaining or 
has recurred, which needs to be broken up. 

Sometimes the uterus is in such a condition, that when the 
pessary is apparently in place, there is an escapement of the 
os tineas out of the cavity prepared to hold it, consequent on 
enlargement of that portion of the organ. When this cir- 
cumstance occurs, it produces much inconvenience, which 
requires correction. 

If the patient complain of pain or soreness after the intro- 
duction of the pessary, the inconvenience here referred to 
should be suspected, and an examination should be made to 
ascertain the true position of the instrument, and if the os 
tincae be dislodged it should be replaced. 

In withdrawing the instrument, a rotary motion should be 
given it, so as to dislodge the neck of the uterus from the 
cavity, which, without this precaution, might produce pain 
and subsequent soreness. 



TOXYCOLOGY. 



REMEDIES IN CASES OF POISONING AND OF ACCIDENTS, 

£y Professor Orfila, of Paris, recommended by the French Institute in 
their Report, to be ordered by government, that a copy should be kept 
for immediate reference in all the public offices, as well as in every 
private house in the kingdom ; with numerous additions to the 
original, of the newest discoveries, and importont correc- 
tions from Andral, Apjohn, Beck, Sir C. Bell, Chris- 
tian, Cooper, Dumas, Edwards, Fodere, S. K. J. 
and others. 



GENERAL SYMPTOMS OF POISONING. 

A person is supposed to be poisoned, if being in perfect 
health he be attacked, after having taken some food or drink, 
with violent pain, cramp in the stomach, nausea, vomiting, 
convulsive actions, and a sense of suffocation ; or if he be 
seized, under the same circumstances, with giddiness, deli- 
rium, or unusual drowsiness. Beck. 

The effects of poisoning may, in most cases, be known and 
distinguished from natural diseases or sudden illness, by the 
following symptoms : 

1. The person, when in a state of perfect health, becomes 
all at once very ill, sick, with violent pain in the stomach, 
burning in the throat, and retching. 

In sudden apoplexy, the stomach and throat are not affect- 



534 APPENDIX. 



ed. In cholera and internal inflammations, there is no burn- 
ing in the throat before vomiting begins. — Apjohn. There 
is also a feverishness not observed at first, in poisoning. — 
Fodere. 

2. The effects of a strong dose of poison usually show 
themselves in a few minutes, though others not for some 
hours. After a meal or eating, when a person is taken very 
ill, poisoning may be suspected. — -Christison. 

Apoplexy, cholera, and inflammation, which also appear 
suddenly after eating, may be distinguished as above. 

3. The effects of poisoning not only appear suddenly, but 
increase rapidly and alarmingly, after or within an hour, and 
sometimes prove fatal in a few minutes. 

Internal inflammation, diseases of the heart, cholera, plague, 
apoplexy and some other diseases, that often end fatally with- 
in a few hours, may be distinguished from poisoning, by 
what is said above, as well as from individual circumstances. 

4. The effects of poisoning most usually increase without 
intermission of their severity, and are also, for the most part, 
uniform in kind. 

Internal inflammations, and some of the diseases already 
mentioned, have often the same character, and can only be 
distinguished by circumstances. — Christison. 

WHAT TO DO IN GENERAL. 

When it is strongly suspected from the above symptoms, 
that poison has got into the stomach, though it be not 
known what sort of poison, not a moment is to be lost 
in removing it, by means of the stomach pump, if one 
be at hand, and if not, by promoting full and copious 
vomiting. For this purpose, the most speedy means are, 
the tickling of the back part of the mouth with a feather, 
and repeatedly thrusting the finger as far back into the throat 
as possible. When the gullet is much inflamed, however, 



APPENDIX. 535 



none of these means can be employed. Other means to be 
used, are given below. 

Irritant, Caustic, or Corrosive Poisons. 

This division comprehends strong or concentrated acids 
and alkalies, metallic preparations of antimony, arsenic, bis- 
muth, copper, lead, mercury, tin and zinc, phosphorus, can- 
tharides or blistering fly, and acrid plants. 

General Effects. — All the poisons of this division, pro- 
duce inflammation of the parts which they touch, in differ- 
ent degrees ; sometimes, as in the case of acquafortis, harts- 
horn or Milestone, they burn as violently as a red hot iron 
would do, causing death in the same way as burning by fire ; 
sometimes, as in the case of arsenic and corrosive sublimate, 
without burning the parts so intensely, they get into the 
blood, and prove rapidly fatal, by destroying the vitality of 
the heart, of the lungs, and of the brain. 

POISONING BY STRONG CONCENTRATED ACIDS. 

COMMON NAME. CHEMICAL NAMES. 

Spirit of Salt — Muriatic Acid. Hydrochloric Acid. 

Aquafortis. Nitric Acid. 

Oil of Vitriol — Spirits of Vitriol. Sulphuric Acid. 

Acid of Phosphorus. Phosphoric Acid. 

General Effects. — Instantly after swallowing a strong acid, 
a very disagreeable, sour, burning taste is felt in the mouth ; 
belching acrid gas ; an acrid heat in the gullet and stomach : 
a very sharp pain, and feeling of tightness in the throat ; great 
difficulty or impossibility of swallowing • the breath becomes 
insupportably foetid ; retching and copious vomiting ensue of 
bitter stuff, sometimes mixed with blood ; there are hiccough 
and sometimes costiveness, but oftener copious stools, more 
or less bloody ; colic and tenderness of the belly, so as to 
render even a shirt too heavy to be borne ; oppressed breath- 
ing ; burning thirst, increased by drinking, all drink being 
soon vomited ; cold, clammy sweats ; repeated and vain ef- 
forts to make water ; distressidg restlessness : convulsive 



536 APPENDIX 

movements of the lips, face and limbs ; the countenance is 
pale, ar lead colored ; while the mind for the most part re- 
mains unaffected till death, which occurs in two hours to 
half-a-day, and sometimes from three to seven, or even fif- 
teen days. — Christison. 

Mistakes of cholera for irritant poisoning may be prevent- 
ed by knowing, that in cholora there is no blood vomited, 
and no heat and pain of the throat until after vomiting has 
begun. In violent colic there are no vomiting and purging. 
In inflammation of the intestines, there is always fever, which 
does not at first occur in poisoning. — Fodere. 

WHAT TO DO IN POISONING BY- STRONG ACIDS. 

Antidotes, or Counter Poisons. — The best counter poison 
is magnesia, (but not calcined magnesia — Aikin>) which 
should be given without losing a moment, or the patient will 
be lost, by mixing an ounce in a pint of water, and giving a 
glassfull of this every two minutes. When magnesia is not 
at hand, dissolve half an ounce of soap in a pint of water. 
When neither magnesia or soap are to be had, beat down the 
plaster of a room, and make it into a thin paste with water, 
( Christison.) and let it be instantly swallowed, in order to 
neutralize the poison. Enemas or clysters of the same should 
also be given. 

Other Treatment. — The stomach pump cannot always be 
used, from the inflamed state of the gullet ; and hence it is 
much better to promote vomiting than waste time with it. 
This must not be done by tickling the throat with a feather, 
or the finger, but by giving water, milk and water, whey, 
barley water, gum arabic water, or linseed tea. The inflam- 
mation of the gullet and stomach must be also immediately 
relieved by putting from twelve to thirty leeches on the parts 
where there is most pain, fomenting the stomach with water 
in which chamomile and poppy heads have been boiled. A 
warm bath will also be advisable. (Use the vapor bath — 
£. K. J.) No food, not even the weakest broth or tea, must 



APPENDIX. 537 



be taken, till the inflammation is subdued ; but when the 
cramps or convulsions disappear, a little gruel, or veal, or 
chicken broth may be given ; and no solid food for some 
time* 

POISONING BY OXALIC ACID, OR ACID OF SUGAR. 

This acid, used chiefly for cleaning brass, or boot tops, 
and removing ink spots, was not known to be poisonous till 
1814, since when numerous fatal cases have occurred by mis- 
taking it for Epsom salts, which it resembles so closely in 
appearance, that the salts ought always to be tried before 
taking them, by putting a crystal in a penful of ink, which 
will not be changed by the salts, but will become reddish 
brown with oxalic acid. 

Effects when swallowed. — If abut half an ounce, or even 
less, of oxalic acid be taken into the stomach, it very rapidly 
produces effects like burning or scalding in the mouth or gul- 
let, the tongue and gums swelling, and smart violent burning 
pains arising in the throat and stomach. This is usually (not 
always) followed by excessive vomiting of a dark colored, or 
sometimes bloody matter, which continues till near death ; 
sometimes (not always) there is violent purging. The skin 
becomes cold and clammy, the pulse at the wrist can scarce- 
ly be felt, and torpidity and drowsiness — great sinking and 
weakness, with change of the countenance, announce death 
to be near. 

Where the acid is taken in smaller quantity, or diluted with 
about twenty times its weight of water, it does not produce 
the violent burning pains, but attacks the heart, the brain, 
and the nerves, stopping the motions of the heart, producing 
apparent death, or suspended animation, by paralyzing the 
organs of breathing, while symptoms ensue resembling lock- 
jaw, followed by death. In still smaller doses, it causes 
great weakness of the limbs, pains in the back and numbness, 
without proving fatal. — Christison. 



538 APPENDIX. 



WHAT TO DO. 

Antidotes, or Counter Poisons. — Oxalic acid acts with 
such dreadful rapidity, that remedies must be given on the 
instant. The best are chalk, magnesia, (not calcined.) or 
the mortar or plaster taken from a wall, mixed thick in cold 
water, and swallowed copiously. — Christison. Any one of 
these combines with the acid, and forms an insoluble salt. 
Solution of soap, or soda, or potass, must not be given. 

Other Treatment. — Carefully avoid giving water or drink 
to promote vomiting, for by diluting the acid, it is rendered 
easier to be carried into the blood. — Christison. After giv- 
ing any of the counter poisons, the stomach pump may be 
used, or a smart emetic taken. When the immediate dan- 
ger is over, if there be no pain in the gullet, the stomach, or 
the bowels, the patient may have some wine, or spirits and 
water, to rouse him, and have hot fomentations, or a mustard 
poultice, applied to the stomach. — Beck. Use our bath. — &. 
K. J. 

POISONING BY STRONG or CONCENTRATED FIXED ALKALIS. 

COMMON NAMES. CHEMICAL NAMES. 

Caustic Potash. Hydrate of Potass — Potassa Fusa. 

Salt of Tartar, Oil of Tartar. Carbonate of Potass — Subcarbonate of 

Potass. 

Caustic Soda. Oxide of Sodium. 

Washing- Soda — Kelp, or Barilla. Carbonate of Soda — Subcarb. Soda. 

Lime — Quicklime. Oxide of Calcium. 

Slaked Lime. Hydrate of Lime. 

Lime Water. Solution of Lime. 

Effects when sioalloiced. — The most remarkable difference 
from the effects of strong acid is, in the case of alkalies, a 
peculiar styptic, acrid, burning, and urinous taste in the 
mouth, produced by potass or soda, destroying the skin lin- 
ing the mouth and gullet, and. causing a burning pain, with 
tightness like strangling, and great difficulty or incapability 
of swallowing, with violent retching and vomiting, often 
mixed with blood, tasting urinous, and changing vegetable 
blue colors green. These first effects are followed by sharp 



APPENDIX. 539 



pains at the pit of the stomach, and great tenderness of the 
whole belly, from internal inflammation, and often actually 
burning through the stomach. In the third stage, there are 
excessive weakness, cold clammy sweats, hiccough, convul- 
sive twitching of the limbs, and trembling, followed by tor- 
turing colic, and purging of dark or bloody matter. These 
symptoms precede death, which may take place in less than 
twenty-four hours. — Christison. The mind is usually more 
or less deranged. — Beck. Sometimes the first symptoms 
remit, and the patient continues to live for some weeks, or 
months, but is at length exhausted by purging and incapa- 
bility of swallowing food. — Dewar and Sir C. Bell. 

WHAT TO DO. 

Counter Poison, or Antidoes. — Let no time be lost in giv- 
ing vinegar, or lemon juice, in the quantity of two table- 
spoonfuls in a glass of water ; and, if this be not at hand, a 
few drops of elixer of vitriol, [sulphuric acid,] or spirit of 
salt, [hydrochloric acid,] (Apjohn,) may be added to the wa- 
ter, so as to render it about as sour as weak vinegar. Oil, 
such as olive oil, or oil of almonds, given freely, is also good, 
by converting the potass, or soda, into soap, and promoting 
vomiting. — Chereau. 

Other Treatment. — Besides these counter poisons, bland 
drinks, such as barley water, gruel, linseed tea, milk, whey, 
and jellies, may be given, to sheath the virulence of the poi- 
son. The internal inflammation must be subdued by twelve 
or more leeches applied to the pit of the stomach and to the 
throat, or by cupping or the lancet. The tender state of the 
gullet will often render it impossible to introduce the stom- 
ach pump, or to tickle the throat with a feather or the finger. 
Milk, warm water, or weak chamomile tea, are best for pro- 
moting vomiting ; all strong emetics being improper. (After 
all the bath.— S. K. J.) 



540 APPENDIX. 



POISONING BY AMMONIA AND ITS SALTS. 

CO>E>IO>" > _ AMES. CHEMICAL >'<LMES. 

Volatile Alkali. Solution of Ammonia — Liquor Am- 

monia?. 
Smelling Salts-Volatile Salts-Harts- Sesqui-Carbonate of Ammonia, 

horn. 
Sal Ammoniac — Baker's Salt — Mu- Hydrochlorate of Ammonia, 

riate of Ammonia. 

Effects when swallowed. — These are nearly the same as in 
the case of potass and soda, with the addition of a pungent, 
suffocating, burning sensation, caused by the vapor or gas of 
the ammonia. This poison also, much more rapidly, brings 
on dreadful convulsions and cramps, resembling those of 
lock-jaw. — Apjohn. When taken in smaller quantity, it 
causes bleeding from the mouth, the nose, and the bowels ; 
makes the teeth drop out, and brings on a fatal hectic. — 
Huxham. 

Effects when the Vapor is breathed. — When smelling salts 
are incautiously held long to the nostrils of persons who have 
fainted, the vapor inflames the throat and lungs, and produ- 
ces burning pain in the mouth and throat, great difficulty of 
swallowing, oppressed breathing, and distressing cough. — 
Nysten. The bottle of smelling salts should only be appli- 
ed from time to time ; three parts of water may be added to 
weaken its virulence. — Apjohn. 

WHAT TO DO. 

Counter Poison, or Antidotes. — As in the case of potass 
and soda, vinegar is the best counter poison of ammonia — 
(Beck) — and when that is not at hand, lemon juice, or any 
vegetable acid : but unless very speedily taken, the vinegar 
will be of no use : for death has occurred in four minutes 
from this poison. When the vapor has been breathed in in- 
jurious quantity, the vapor of hot vinegar may be inhaled by 
the mouth and nostrils. 

POISONING BY IODINE AND ITS SALTS. 

Effects when swallowed. — In the quantity of from ten to 
twenty grains, it produces metallic taste in the mouth : a 



APPENDIX. 541 



sense of tightness and strangling in the throat, nausea, severe 
pain at the pit of the stomach, increasing on being pressed ; 
retching, vomiting, colic, palpitation, trembling, blood-shot 
and throbbing eyes, with sinking of the pulse. — Jahn. 

WHAT TO DO. 

Counter Poisons, or Antidotes. — Dissolve a quantity of 
white (not blue) starch, arrow root, or wheat flour, in water, 
and give it immediately, as a probable antidote. — Apjohn. 

Other treatment. — When the pain of the stomach is dis- 
tressing, apply leeches and fomentations ; and give for drink, 
barley water ; or what is better, rice water, if it can be had • 
alternating the bath. — S : . K. J. 

POISONING BY MERCURY. 

COMMON NAMES. CHEMICAL NAMES. 

Corrosive Sublimate — Muriate of Mer- Bichloride of Mercury 

cury — Oxy-muriate of Mercury 

Calomel Chloride of Mercury 

Red Precipitate Nitric Oxide of Mercury 

Vermillion, or Cinnabar Bisulphuret of Mercury 

Turbeth Mineral Sub-Sulphate of Mercury 

Prussiate of Mercury Percyanide of Mercury 

Effects of swallowing Mercury. — When one grain, or 
more, of corrosive sublimate, or over doses of the other mer- 
curial preparations have been swallowed, the effects are more 
rapid and powerful than even those of arsenic, causing a 
most disgusting metallic taste, somewhat like that of rue, in 
the mouth ; an acrid dryness in the throat, with a sense of 
tightness and strangling ; pain in the back part of the mouth, 
the stomach, and the bowels, which soon becomes insupport- 
ably severe ; nausea, belching of foetid air j inclination to 
vomit, retching, and at length vomiting, and purging of 
bloody matter ; hiccough, oppressed breathing, difficulty df 
swallowing, unquenchable thirst ; difficulty of making water, 
cramp, clammy skin, icy coldness of the hands and feet; 
alarming weakness and sinking ; change of the countenance, 
which is usually swelled or flushed ; dreadful convulsions 
and delirium precede death, which takes place in from twen- 



542 



APPENDIX. 



ty-four to thirty-six hours ; or sometimes in three days or 
more, according to the quantity taken, and to the constitu- 
tion of the patient. 

Effects when applied externally. — When corrosive subli- 
mate, or other strong mercurials, are applied to wounds or 
sores, or even to the unbroken skin, in the form of 
dangerous cosmetics, or to destroy vermin in the hair, 
similar effects, more or less violent, are produced as those 
just mentioned ; particularly cramp, and inflammation of 
the stomach and bowels, intense head-ache, cold sweats, 
convulsions, and death in from ten to thirty hours. 

WHAT TO DO. 

Counter Poisons, or Antidotes. — As quickly as possible, 
mix up the whites of a dozen eggs or more, with two pints 
of cold water, and give a glassful of the liquid every two 
minutes, till the stomach can contain no more, in order to 
promote vomiting. When fewer eggs only are at hand, use 
all there are, and supply the deficiency with milk. The dried 
gluten of wheat, or even wheat flour itself, mixed with water, 
is also a good counter poison to corrosive sublimate. — Taddei. 

Other treatment. — When no eggs, milk, wheat gluten, nor 
wheat flour are at hand, linseed tea, sugared water, barley 
water, or other bland drinks, should be copiously given ; and 
vomiting should be provoked, if the gullet be not inflamed, 
by tickling the throat with a feather, or with the finger. If 
the stomach pump is at hand, it ought to be employed with- 
out delay. When inflammation of the stomach and bowels 
comes on, leeches, and fomentations of poppy water, must be 
applied. Also, the bath. — *S\ K. J. 

POISONING BY ARSENIC. 

COMMO>~ NAMES. CHEMICAL NAMES. 

White Arsenic — Oxide of Arsenic — Arsenious Acid 

—Fly Powder 

Macquer's Salt of Arsenic — Arseniate Arsenite of Potass 

of Potash 

Orpiment — King's Yellow — Rusma Sesqui-Sulphuret of Arsenic 

Realgar Red Sulphuret of Arsenic 



APPENDIX. 543 



Fowler's Solution — Tasteless Ague Solution of Arsenite of Potass — 

Drop Liquor Arsenicalis 

Arsenical Paste — Plunket's Remedy Contain Arsenious Acid 
for Cancer 

Effects token swallowed, or introduced internally. — As 
these effects vary in different individuals, from difference of 
constitution, they are classed under three varieties. 

1st Variety. — In about half an hour, or more, after the 
arsenic is introduced into the body, nausea and faintness 
come on, soon succeeded by burning pain in the stomach, 
and obstinate vomiting of yellowish green matter, much in- 
creased by any sort of drink ; and after a time, more or less 
blood is generally brought up. Along with the vomiting, 
there are heat, dryness, and a tight strangling sensation in 
the throat, with unquenchable thirst ; the voice becomes 
hoarse, and speaking painful j gripes, and purging of green, 
watery, viscid matter, usually (not always) sets in with much 
irritation, and vain straining at stool ; the belly is tense and 
painful ; the pulse quick, and the heart flutters ; the skin is 
cold and clammy; palsy of the extremities, convulsions, and 
in some cases delirium, precede death, which occurs in from 
twenty-four hours to three days. — Apjohn. 

2d Variety. — When solid lumps, or a very large dose of 
arsenic, has been introduced, death ensues with great rapidity 
in about six hours or less, with little or no irritation, but ex- 
cessive faintness, stupor, and slight convulsions ; sometimes 
there are trivial vomiting and pains of the stomach. — Chris- 
tison. 

3d Variety. — The patient sometimes lives six days, and in 
rare cases partially recovers ; the effects being at first the 
same as in the first variety, the vomiting, &c. being, perhaps, 
more violent, followed about the second or fourth day by 
palsy, epilepsy, hysteric lock-jaw, and sometimes outrageous 
madness. — Christison. 

Effects ichen externally applied. — When arsenic is applied 
to cancerous sores, as in the form of arsenical paste, or of 



544 APPENDIX. 



Plunket's or Aldis's remedies, or to destroy vermin, itch, and 
the like, it does not affect the stomach so much as the nerves, 
producing giddiness, fainting, trembling of the limbs, heart- 
burn, excessive thirst, scalding on making water, slight vom- 
iting, delirium, and death in from twenty-four to forty-eight 
hours. 

WHAT TO DO. 

Counter Poiso?is, or Antidotes. — No specific counter poi- 
son is yet discovered ; though lime water may be tried, pre- 
pared by heating for five or six minutes, a quarter of an 
ounce of slaked quick-lime in two pints of water, straining 
the liquor through a linen cloth, and giving several succes- 
sive glasses of this, mixed with equal parts of sugared water. 
Dr. Christison, however, says this is absolutely useless. 

Other treatment. — The stomach pump, if one can be im- 
mediately had, is here most valuable (Apjohn :) and if not. 
exciting vomiting by tickling the throat with a feather or the 
finger. Vomiting must also be promoted by drinking copi- 
ously so as to fill the stomach with warm or cold milk, water, 
sugared water, linseed tea, or barley water. When vomiting 
cannot easily be excited, an emetic of 24 grains of the sul- 
phate of zinc should be given. — Christison. Enemas of cas- 
tor oil, and suppositories prepared with opium, are highly 
valuable. — Ryan. 

Useless Remedies. — Treacle, oil, gall nuts. Peruvian bark, 
the bark of pine and pomegranates, liver of sulphur, or sul- 
phuret of potassium and vinegar, formerly recommended, are 
not only useless, but often, as in the case of the liver of sul- 
phur, even dangerous. The more recently vaunted remedies 
of magnesia and charcoal are, at best, of extremely doubtful 
utility. — Christison. 

After Treatment. — Bleeding from the arm seems to be de- 
cidedly advantages, [followed by the bath. — &. K. J.] Blis- 
ters to the belly, with opiates, anodynes, mild laxatives, and 
bland (not stimulating) food, are most advisable. — Christison. 



APPENDIX. 544 



The hydrated sesqui-oxide of iron has been discovered to 
act as an antidote to arsenious acid. The best process to ob- 
tain it, consists in oxidizing, with the assistance of heat, a 
solution of protosulphate of iron, by adding to it nitric acid 
in small portions at a time. Precipitate the solution thus ob- 
tained by caustic ammonia, and wash the sesqui-oxide by 
agitating it with water several times ; decant the supernatent 
liquid, and preserve the hydrate under water in close stop- 
pered vessels. — Bunsen and Burthold. 

The above substance is not recognized as an absolute an- 
tidote to arsenic. See Schultz in Hufeland's Journal, Janu- 
ary, 1838. 

POISONING BY COPPER. 

COMMON NAMES. CHEMICAL NAMES. 

Verdigrise — Oxide of Copper. Diacetate of Copper. 

Verdigrise Chrystals. Pure Diacetate of Copper. 

Blue Stone— Blue Vitriol — Blue Copperas. Sulphate of Copper. 

Verditer — Copper Nitre. Nitrate of Copper. 

By using untinned copper vessels for cooking, or by pre- 
serving in these vessels articles of food, such as pickles, pre- 
serves, or milk, as well as copper stop-cocks, when any acid 
or grease is present, as is almost always the case, a poisonous 
salt is produced, which may cause deleterious consequences. 
— Apjohn. Cooking in very clean copper vessels at a high 
heat, and removing the material before cooling, is safe. — 
Proust. 

Effects when swallowed. — When any of the above salts of 
copper are taken by accident or design, there are produced an 
acrid, styptic, disgusting, coppery taste in the mouth ; with 
a dry parched tongue, a sense of strangling, tightness in the 
throat, coppery belchings, continual spitting ; nausea, copi- 
ous vomiting, or distressing and vain efforts to vomit ; shoot- 
ing, and often severe, pains in the stomach ; dreadful griping ; 
frequent purging, sometimes of black or bloody matter, with 
much vain straining at stool ; the belly is painful to the touch, 
and swells up ; there are great heat of the skin, and burningj 
35 



546 APPENDIX. 



unquenchable thirst; succeeded by jaundice (never occurring 
from arsenic or mercury,) and by great weakness and faint- 
ness, difficulty of breathing, violent head-ache, giddiness, 
cold sweats, scanty urine, cramps of the legs, convulsions, 
and death. 

Counter Poisons, or Antidotes. — The best antidote for 
neutralizing poisonous salts of copper in the stomach is, white 
of eggs, of which one dozen, if so many can be had, should 
be mixed with a pint or two of water, and taken in glassfuls 
every two minutes. The next best is Prussian blue, or per- 
cyanide of iron; or an ounce of fine, clean, iron filings may 
be taken in milk, or other bland fluid. — Edwards and Du- 
mas. 

Useless and Dangerous Antidotes. — Liver of sulphur, or 

sulphuret of potassium, alkalies, gall-nuts, bark, charcoal, 
particularly vinegar, formerly recommended, must not be 
given. 

Other Treatment. — Sugar, though not as at first supposed, 
an antidote, will be of advantage, given in coffee, or water, to 
promote vomiting ; and this may also be provoked, if it do 
not come on of itself, by tickling the throat with a feather or 
the finger. The stomach pump will only be available when 
employed early. When there is great pain of the belly, or 
at the pit of the stomach, leeches will be advisable. [Say 
bleeding, following it with the vapor bath. — &. K. J.] 
POISONING BY ANTIMONY. 

COMMON NAMES. CHEMICAL NAMES. 

Tartar Emetic — Tartarized Antimo- Totassio-Tartrate of Antimony. 

ny — Antimoniated Tartar. 
Butyr, or Butter, of Antimony— Mu- Chloride of Antimony. 

riate of Antimony. 
Kermes Mineral. Hydro-Sulphate of Antimony. 

Glass of Antimony. Oxide of Antimony. 

James' Powder. 

Serious consequences often ensue by putting tartar emetic 
into tea, liquors and the like, for the purpose of detecting do- 
~^stic pilferers, by making them ill, {Christison ;) and by 
the ignorant use of James' Fever Powders. 



APPENDIX. 547 



Effects token swallowed. — The common effects produced 
are, a rough, metallic taste in the mouth, nausea, copious 
vomitings, frequent hiccough, severe heart-burn, burning 
heat, and pain at the pit of the stomach, griping colic, purg- 
ing, fainting ; the skin, in some cases, cold ; in others, burn- 
ing hot ; difficult breathing, giddiness, like intoxication, loss 
of sense, convulsive motions, distressing cramps in the legs, 
and death. Sometimea there is great difficulty, or impossi- 
bility of swallowing, from the tightness and strangling sen- 
sation in the throat • sometimes, when there is no vomiting 
or purging, the other effects are more severe. — Beck. 

Effects when externally applied. — In the form of ointment, 
as used by the late empiric, St. John Long, and scientifical- 
ly recommended by the late Dr. Jenner, tartar emetic may 
cause not only painful tumors and bad ulcers, but nausea, 
vomiting, and even death. — Francis in Beck. 

Counter Poison, or Antidotes. — The decoction or tincture 
of galls, when at hand, should be given to neutralize the 
poison. The yellow Peruvian bark, from containing gallic 
and tannic acid is, by some, recommended as the best anti- 
dote, and may be given in powder, in tincture, or in decoc- 
tion, repeating the doses. — Apjohn. 

As Antidotes — Ipecacuanha, blue vitriol, or sulphate of 
copper, white vitriol, or sulphate of zinc, should not be giv- 
en to promote vomiting. 

Other Treatment. — The vomiting, when it begins, must be 
promoted by several glasses of plain water, or sugared water; 
but when vomiting has continued some time, with increasing 
pains, one grafn of extract of opium, or an ounce of syrup of 
poppies, dissolved In a glass of sweetened water, should be 
given thrice, at intervals of a quarter of an hour. If the 
symptoms continue to increase, a dozen leeches or more, 
should be applied over the pit of the stomach ; and if there 
be much sensation of strangling in the throat, the name num- 
ber of leeches may be applied there. [Bleed and apply the 
bath.— S. K. J A 



548 APPENDIX. 



POISONING BY TEN' 



COMMON NAME. C HEMIC AJL 5"AMES. 

Butter of Tin— Sal-, of Tin—Muriate of Tiil Bichloride of Tin, 

Potty P i wder— Flowers of Tin — Worm Powder. Oxide of Tin. 

These preparations are used in dying, and the arts: and 

in one case the salt of tin was mistaken and used by a 

for common salt, Meralic tin is no: poison: '.;s 

Ejects when swallowed. — There are produced, by small 

doses, colic and pinging : and by larger doses ; when given 

to brute animals, palsy, convulsions, and death. 

Counter Poisons, or Antidotes. — The best counter poison 

i. is milk, but till this is procured, warm or cold i 

should be given to promote vomiting. 

O+her treatment. — The colic may be relieved by leeches 

and fomentations, the convulsions, by opium, or syrup of 

ies, as recommended for antimony. [According to the 

severity of the symptoms, bleed and use the bath.—S". K. J.] 

POISONING BY ZINC. 

COMMON NAME;. CHEMICAL >A V 

\ V bite Vitriol — White Copperas — Vitriol of Zinc . B . I : I rte :: Z inc. 

rs of Zinc— Nihil Album. Oxide of Zinc. 

Vessels made of zinc should not be used for milk, nor in 
the kitchen, it is also dangerous to use zinc for water pipes. 
as it readily oxidizes. — Proust. 

Effects when swallowed. — VVhen taken in larger doses than 
a drachm, the salts of zinc are apt to produce dangerous vom- 
The usual effects are. an astringent; metallic taste in 
the mouth, a sense of strangling, tightness in the throat, nau- 
sea, copious vomiting and purging, pains at the pit of the 
stomach, extending over the belly, difficulty •of breathing. 
palettes ol the face, cold and clammy skin : but seldom death. 

— Beck. \ 

WHAT TO DO. 

Give copious draughts of milk, or milk-warm water, to 
render the vomiting easy. The pain in the stomach, and 
lightness in the throat, may be relieved by leeches and fo- 
mentations — [better by bleeding and bathing. — S. K. J.\ 



APPENDIX. 549 



POISONING BY SILVER. 

COMMON NAMES. CHEMICAL NAMES. 

Lunar Caustic—Lapis Infernalis. Nitrate of Silver. 

Fulminating Silver. Ammoniuret of Silver. 

Effects when swallowed. — In doses of more than three 
grains, nitrate of silver will burn the internal parts it touches, 
and produce an ulcer and mortification, with excruciating 
pain. — Boer have. Six grains have been taken with benefit. 
S. K. J. 

WHAT TO DO. 

Counter Poisons, or Antidotes. — A table spoonful of com- 
mon salt, or chloride of sodium, dissolved in two pints of wa- 
ter, or sea water, if at hand, drank copiously, will decompose 
the poison, and produce the harmless chloride of silver, or 
horn silver. For fulminating silver, charcoal powder diffused 
in water, and drank, is said to be the best antidote. — Pagot 
Laforet. 

Other Treatment. — If the vomiting and pain continue dis- 
tressing, recourse must be had to leeches, fomentation and 
bland drinks — [and bleeding and bathing. — S. K. J J] 
POISONING BY BROMINE. 

Chlorine, Bismuth, Gold, Chrome, Platinum, Cobalt, Manganese, Nickel, and 

other metals. 

Effects when swallowed. — These are little known as poi- 
sons ; but produce, more or less, similar effects to iodine, ar- 
senic, mercury, or copper. 

WHAT TO DO. 
The best treatment, in the absence of a knowledge of ef- 
fectual counter poisons, is, to give copius draughts of milk, 
whey, or barley water, to promote vomiting. White of egg 
is an antidote to chlorine. 

POISONING BY NITRE. 

COMMON NAMES. CHEMICAL NAMES. 

Saltpetre— Salt of Nitre. Nitrate of Potass. 

Sal Prunelle. Hydrated Nitre of Potass. 

Saltpetre is sometimes taken in mistake for Glauber's salts, 
with dangerous consequences. 



550 APPENDIX 



Effects when swallowed. — When an ounce or less of salt- 
petre has been taken in the stomach, it gives rise to obsti- 
nate vomiting of bloody matter, inflammation, burning pains 
in the stomach, purging of bloody matter, sinking of the pulse, 
and cold clammy sweats : followed by a sort of intoxication, 
palsy of the limbs, convulsions, fainting, great debility, and 
death in from three to ten, or sometimes sixty hours. — 
Beck. 

WHAT TO DO. 

The poison must be removed as speedily as possible, by 
an emetic of three or four grains of sulphate of copper, or by 
the stomach pump ; and copious draughts of warm water, or 
of any bland liquid, may be given to promote vomiting. 

POISONING BY LIVER OF SULPHUR. 

The liver of sulphur, termed by chemists the sulphuret of 
potassium, as well as the sulphuret of sodium, is used in pre- 
paring medicated baths ; such as Whitlaw : s, which are there- 
fore dangerous. 

Effects when swallowed. — When three drachms, or more, 
of liver of sulphur are taken, there are produced burning 
pain, and sense of strangling in the throat, acrid taste in the 
mouth, frequent vomiting of sulphurous matter ; mortal faint- 
ness, and death in fifteen minutes ; the air of the chamber 
remaining tainted with sulphurous vapor. 

WHAT TO DO. 

Counter Poison, or Antidotes. — Common salt, or chloride 
of sodium and bleaching powder, or chlorinated lime, given, 
dissolved in water, will decompose and render harmless the 
deletereous fumes of sulphuretted hydrogen. — Cliristison. 

Other Treatment. — Put two tablespoonfuls of vinegar, or 
lemon juice, in a tumbler of water, give immediately, and re- 
peat it to promote vomiting. Then apply a dozen leeches, 
or more, to the throat, stomach and belly, to subdue the in- 
flammation — [or bleed and bathe.— &. K. J.] 



APPENDIX. 551 



POISONING BY BARYTA AND ITS SALTS. 

COMMON NAMES. CHEMICAL NAMES. 

Heavy Spar— Ponderous Earth— Barytes Baryta, or Protoxide of Barium. 
Muriate of Barytes-Hydrochlorate of Barytes. Chloride of Barium. 
Cauk— Heavy Stone. Carbonate of Baryta. 

Effects when swallowed.— The immediate effect of taking 
half an ounce, or even much less, of these poisons, are, violent 
vomiting, convulsions, palsy in the limits, head-ache, deaf- 
ness, pains in the belly, hiccough, rending colic, change of 
the countenance, insensibility, convulsions, and death in from 
six minutes to one hour. 

Counter Poisons, or Antidotes.— Half an ounce of Glau- 
ber's or Epsom salts, dissolved in a pint of water, should be 
given immediately ; and if neither of these be at hand, the 
hardest pump water, or water rendered sour by vitriol, should 
be drank, in order to form thereby the harmless sulphate of 
baryta. 

Other Treatment. — Vomiting should be promoted by giv- 
ing sugared water, or any bland drink. 

POISONING BY PHOSPHORUS. 
Effects when swallowed. — If phosphorus, in substance, or 
dissolved in oil, or in water, be taken into the stomach, it 
catches fire and burns, producing inflammation, vomiting, ex- 
haling the smell of garlic, violent convulsions, distressing 
priapism, and death in forty hours or more. 

WHAT TO DO. 
It is advisable to give an emetic of three or four grains of 
sulphate of copper, to use the stomach pump, and to drink 
copious draughts of water mixed with magnesia. —Beck. 

POISONING BY CANTHARIDES, OR BLISTERING FLIES, AND 
CANTHARIDIN. 

Effects when swallowed.— When taken either in powder, 
or dissolved in a liquid, this poison causes an acrid and very 
nauseous taste in the mouth, a burning heat in the throat, 
stomach and belly, retching, vomiting, and purging of bloody 



552 APPENDIX. 



matter ; excruciating pain in the stomach, distressing pria- 
pism, and heat in the bladder, with pain and great difficulty 
of making water, and then often mixed with blood ; great 
difficulty of swallowing, and sometimes even hydrophobia, or 
dread of water ; the jaws at length become fixed, with gene- 
ral stiffness, frightful convulsions, delirium, and death in four 
days, or less. 

WHAT TO DO. 
Oil, which was formerly recommended as a counter poison 
to cantharides, is now found to be dangerous. The best treat- 
ment is, to use the stomach pump, if it can be instantly had j 
and if not, to give an emetic of three or four grains of sul- 
phate of copper, promoting vomiting by warm water, or cha- 
momile tea. Oil or oil fluids, may be injected into the blad- 
der, or given as enemas or clysters, and the warm bath may 
be used with advantage ; leeches may also be safely applied 
to the stomach. [Bleed and Bathe. — S. K. J.] 

POISONING BY GLASS AND ENAMEL. 
The common opinion that pounded glass is poisonous, is 
not true ; though when glass, in fragments, is swallowed, it 
may occasion serious injury by wounding the internal parts. 

WHAT TO DO. 

The best treatment is, to cause the patient to eat large 
quantities of vegetables ; such as beans, potatoes, cabbage, 
bread or the like, in order to fill the stomach, and protect it 
from the sharp angles of the glass. 

POISONING BY LEAD. 

Lead is frequently contained, by accident, in water kept 
in leaden cisterns, or running through leaden pipes; in milk, 
spirits, wine, beer, cyder, pickles, preserves, orange-flower 
water, &c; when these are kept, or prepared in leaden ves- 
sels. Or it may be introduced intentionally to sweeten sour 
beer, cyder, and wine, or to color cheese, sweetmeats, &c. 

Effects when swalloived. — When sugar of lead, or any of 



APPENDIX. 553 



the soluble salts of lead, are taken in the quantity of two 
drachms, or more, it produces a sugary, astringent, metallic 
and very disgusting taste in the mouth, tightness, and a sense 
of strangling in the throat j pains, more or less severe in the 
stomach ; retching, and obstinate, distressing vomiting, often 
of bloody matter ; but, in general, the effects are much less 
violent, though they usually end in the well known severe 
colic, termed the painter's colic. 

WHAT TO DO. 

Counter Poisons, or Antidotes. — It is the best practice to 
give immediately a large dose of Epsom or Glauber's salts, 
or of plaster of Paris, mixed with the hardest pump water 
that can be procured, any of which will decompose the poi- 
son, and form sulphate of lead, which is harmless. Phos- 
phate of soda is also an excellent antidote. It is dangerous 
to give liver of sulphur. 

Other treatment. — If the patient do not vomit, it will be 
proper to use the stomach pump ; to give an emetic of 24 
grains of sulphate of zinc, (Christison;) and to subdue in- 
flammation by leeches or blood-letting. — S. K. J. 

Effects of the Fumes of Lead. — When persons sleep in 
fresh painted rooms, and painters, miners, white lead manu- 
facturers, or others, are much exposed to the fumes of lead, it 
frequently brings on distressing colic, termed the lead or 
painter's colic ; with dryness of the mouth, vomiting, cos- 
tiveness, numbness, or palsy in the limbs. 
WHAT TO DO. 

The best treatment is to give a smart dose of Epsom salts, 
followed in an hour by a grain of opium, or sixty to a hun- 
dred drops of laudanum ; and repeating these two medicines, 
if necessary. " I have never seen the second dose fail to re- 
move the colic." Christison. When palsy occurs, the 
bowels must be kept open, spirits applied to the palsied limbs, 
(Apjohn;) and the patient ought, if possible, to change his 
employment. 



554 



APPENDIX. 



POISONING BY ACRID PLANTS. 
Effects of acrid Vegetable Poisons when swallowed. — Soon 
after swallowing any of these poisons, there is felt an acrid, 
biting, more or less bitter taste in the mouth, with great dry- 
ness and burning heat : the throat becomes painfully tight, 
with a sense of strangling, distressing retching, vomiting and 
purging, and pains more or less severe in the stomach and 
bowels ensue ; and these are succeeded by a quick and 
throbbing pulse, oppressed breathing and panting, a tottering 
gait, as if the patient were intoxicated, alarming weakness, 
sinking, and death. Sometimes there are convulsions more 
or less severe, acute pain, and causing plaintive cries, with 
stiffness of the limbs. The several poisons of this class, 
vary much in the violence of their effects. 

WHAT TO DO. 

The first thing is, to remove the poison from the stomach 
by means of the stomach pump, if one be at hand, or by 
tickling the throat with a feather or the finger, or by an 
emetic of 24 grains of sulphate of zinc, (but not tartar emetic 
nor any acid.) promoting the vomiting by copious draughts 
of warm water, sugared water, barley water, milk, or other 
bland liquid, (but by no means vinegar.) When stupor, or 
intoxication, comes on, give several cups of strong coffee, 
made by pouring a pint of boiling water on eight ounces, 
and straining it through linen or blotting paper : it must not 
be boiled. If the coffee do not remain on the stomach, some 
may be given in the form of enema or clyster, and three or 
four grains of camphor may be taken in the yolk of an ess. 
Laudanum or decoction of poppies will be useful to subdue 
convulsions ; and leeches to lessen the pain of the belly. 

Effects when applied to the skin, or to ivounds and sores. 
When acrid vegetable poisons are rubbed upon the skin, or 
applied to sores or wounds, they not only produce great irri- 
tation of the parts, but often a spreading inflammation, some- 



APPENDIX. 555 



times affecting the stomach and bowels, as in the case of cro- 
ton oil, in the same way as when swallowed. 

WHAT TO DO. 
With the exception of exciting vomiting, the treatment 
must be similar to what has been directed, when the poison 
has been swallowed. 

II. Stupefying, or Narcotic Poisons. 

This division comprehends certain plants, such as poppy, 
henbane, bitter sweet, poison lettuce, yew leaves, bay, cher- 
ry laurel, and vegetable productions, such as opium and prus- 
sic acid. 

General Effects, — These poisons in general act with great 
rapidity; producing stupor, drowsiness, palsy, apoplexy, con- 
vulsions, and death. 

Mistakes of poisoning, for natural diseases they may resem- 
ble, may be avoided, by considering, that a fit of apoplexy or 
epilepsy, usually gives warning, for some days, by headache, 
giddiness, &c, and comes on abruptly; while narcotic poison 
comes on gradually. There is, in inflammation of the brain, 
usually fever ; in narcotic poisoning, none. — Christison. 

POISONING BY PRUSSIC ACID. 

The prussic acid, termed by chemists hydrocyanic acid, is 
contained in cherry-laurel, cherry-laurel water and oil, in the 
peach, in the bird cherry, or hagberry, in the sloe, in the bul- 
lace, in the common cherry, in the bitter almond, in the moun- 
tain ash or rown tree, and in the kernels of most stone fruit. It 
is the prussic acid which gives to these, and to sherry wine, the 
agreeable bitter nutty flavor. The strong acid is rarely made. 

Effects when swallowed, or applied externally. — This is 
the most powerful and rapid poison known, as one or two 
drops put into the eye, or on the tongue of the strongest dogs, 
will kill them in one or two minutes. When a person swal- 
lows a quantity not sufficient to prove instantly fatal, it pro- 



556 APPENDIX. 



duces weight and pain in the head, particularly in the back 
part of the head, rapid pulse, nausea, and sometimes saliva- 
tion. In a large dose, death is preceded by convulsions, re- 
sembling lockjaw. In cases instantly fatal, the patient dies 
almost as if shot. — Apjohn. 

WHAT TO DO. 

Counter Poison, or Antidoes. — Solution of chlorine or of 
ammonia smelling salts, or hartshorn, should be applied, by 
a feather, to the nostrils, or by holding the head over a ves- 
sel containing the chlorine, diluted with about twelve wa- 
ters, to prevent inflammation from the vapor. 

Other Treatment. — Cold water should be dashed over the 
patient to rouse him, and repeated every fifteen minutes. 
Herbert. Brandy and water may be also given to support 
the sinking powers. — .4. B. Granville. 

POISONING BY OPIUM AND LAUDANUM. 

The disguised preparations of opium, often given to in- 
fants, such as American Soothing Syrup, Daffy "s Elixir. 
Dalby's Carminative. Godbold"s Balsam. Hive Water, Bate- 
man's Drops, &c, poison many fine babies — a practice well 
exposed by Boz, in his Oliver Twist, and by the Dispatch 
newspaper. 

Effects when swallowed. — The first effects of a poisonous 
dose of opium or laudanum are, in from a few minutes to 
several hours, stupor without previous excitement, giddiness, 
numbness, heaviness of the head, inclination to sleep at first 
slight, and afterwards irresistible, followed by intoxication, 
a stupid look, and furious or merry delirium. Sometimes 
pain and convulsions more or less severe, palsy of the legs, 
and death. In eases of recovery, the patient may sleep for 
twenty-four or thirty-six hours, and awaken with nausea 
and vomiting. 

WHAT TO DO. 

The stomach pump, if at hand, must be instantly had re- 
course to do ; and. if not, tickling the throat with a feather. 



APPENDIX. 557 



or the finger may be tried. Emetics dissolved in a small 
quantity of water, may also be tried ; such as twenty-four 
grains of sulphate of zinc, or three or four grains of sulphate 
of copper, or one grain of tartar emetic, repeated, if necessa- 
ry; but the stomach is so often torpid, that vomiting cannot 
be produced ; in such cases, dashing cold water over the 
head, sometimes rouses the patient and brings on vomiting. 
Grater. The patient should also be dragged up and down, 
between two men, or shaken and driven with speed over 
rough roads, in a cart. Apjohn. Pulling the hair, so as to 
give pain, and ejecting water into the ears, are also recom- 
mended. — Christison. 

No vinegar, lemonade, cream of tartar, coffee, nor other 
liquids, should be given, till the poison is removed from the 
stomach, when they may be of advantage. 

POISONING BY HENBANE, OR HYOSCYAMUS. 
Effects when swallowed. — This poison produces giddiness, 
loss of speech, trembling, intoxication, violent delirium, leth- 
argic sleep, and death. 

WHAT TO DO. 
The treatment must be similar to that just recommended 
in poisoning by opium. 

III. Narcotico-Acrid Poisons. 

Under this division are arranged poisons possessing a com- 
bination of the properties of the first two divisions ; among 
which are certain plants, such as deadly nightshade, hemlock, 
tobacco, and virulent mushrooms ; and certain vegetable pro- 
ductions, such as camphor, ardent spirits, strychnia, and 
spurred rye or ergot. 

POISONING BY DELETERIOUS MUSHROOMS. 

Mushrooms may be suspected, when they grow in moist 
shady places, have many or gaudy colors, are moist, dirty, 
or bitten on the surface, and have soft stems. 



APPENDIX. 



Effects when swallowed. — When poisoned ketchup, or 
stewed deleterious mushrooms, have been taken, in from five 
to twelve hours or more, nausea, heat, and severe pain of the 
stomach, and often vomiting and purging, are produced, with 
insatiable thirst, convulsions, fainting, delirium, stupor, cold 
sweats, and death. 

WHAT TO DO. 

Use the stomach pump, and give emetics, the same as di- 
rected under poisoning by opium. When inflammation of 
the stomach and bowels comes on, leeches should be applied, 
and the bowels cleared by brisk purgatives, such as an ounce 
of Glauber's salts, given in three doses, at twenty minutes 
interval. 

POISONING BY XUX VOMICA. 

Effects when swallowed, or applied to wounds. — The usual 
effect of these poisons is upon the brain and spinal marrow, 
causing convulsive stiffness, with the head drawn back upon 
the shoulders, and the breathing very irregular, often almost 
stopped, when death, without inflammation, speedily ensues. 
Intervals of intermission sometimes take place, but the symp- 
toms soon return with increased violence. Strychnia, next 
to prussic acid, is the most frightful poison known ; the sixth 
part of a grain killed a dog in two minutes ; and one-third of 
a grain killed a wild boar in ten minutes. — Christison. 
Brucia is twenty-four times less powerful. — Andral. 
WHAT TO DO. 

It is of the greatest moment to remove the poison from the 
stomach by the stomach pump, or by tickling the throat 
with a feather or the finger : or an emetic, of 2-4 grains of 
sulphate of zinc, should be given. Iodine or chlorine, are 
newly-reported counter poisons, but a delay of ten minutes 
in giving them, renders them of no avail. — Donne. When 
breathing stops, air must be blown into the lungs, as recom- 
mended below, in # cases of drowning ; and a spoonful should 
be given every ten minutes, of a mixture composed of a 



APPENDIX. 559 



drachm of ether, two drachms of spirits of turpentine, half an 
ounce of sugar, and two ounces of water. 

POISONING BY NIGHTSHADE, HEMLOCK, &c. 

Tobacco, Thorn Apple or Jamestown Weed, Foxglove, Digitaline, &c. 

Effects when swallowed, or applied to a wound. — The 
usual effects are great agitation, pain, piercing cries, convul- 
sive movements of the face and limjDs ; delirium, more or less 
merry; retchings, obstinate vomiting and purging, pains in 
the belly, more or less severe; a sort of intoxication, with 
trembling, great depression, sinking of the pulse, and death. 

WHAT TO DO. 
Similar treatment will be advisable with that directed un- 
der opium, particularly an emetic will be indispensable, fol- 
lowed by a brisk purgative of Glauber's salts. Should there 
be much stupor, blood should be taken from the arm, or from 
the jugular vein ; and a dozen leeches should be applied to 
the belly, with fomentations and draughts of linseed tea, or 
other bland fluids. [After blood-letting, the vapor bath. — 
jST. K. jr.] 

DANGEROUS INTOXICATION, OR POISONING BY INTOXICA- 
TING LIQUORS. 

The alcohol, or spirit of wine, contained in wine, ale, 
beer, cider, or other fermented liquors, when taken in too 
great quantity, is a true poison. 

Effects. — The chief symptoms produced by this sort of 
poisons, are violent excitement, flushing of the face, giddi- 
ness and delirium, soon followed by dozing and dangerous 
sleep, from which the patient only awakens to die. In more 
severe cases, the face becomes livid, or ghastly pale, with 
stertorous breathing, and speedy death. — Christison. When 
the pupil of the eye is dilated and motionless, recovery is 
rare . — Bedingfield. Cold extremities and clammy sweat, 
often accompany the lethargic sleep. 



560 APPENDIX. 



WHAT TO DO. 
The stomach pump is. in dangerous cases of intoxication. 
invaluable, if soon enough procured : and if not. tickling the 
throat ; or a smart emetic should be given, and vomiting 
promoted by warm water, mixed with vinegar or lemon juice. 
The whole body should be rubbed with cloths dipped in 
warm vinegar : and the torpor should be subdued by leeches 
to the neck. 

IV. Putrefying, or Septic Poisons. 

The poisons, in this division, are those derived from ani- 
mals, living or dead, such as poisonous serpents and insects. 
mad dogs, diseased fish, rancid bacon or beef, and the like. 

POISONING BY MUSSELS AND OTHER FISH. 
The fish that have produced the effects of poisoning, the 
causes of which are quite unknown, are the mussel, the oys- 
ter, the crab, the herring, the trout,, the mackerel,, the salmon, 
and the eel. Similar effects have occurred from eating dis- 
eased beef, rancid, or rusty bacon, &c. 

Effects. — In a few hours, and sometimes not for nearly a 
day, after eating the fish or meat, the patient is seized with 
irregular chills, acute pain in the stomach and head : rest- 
lessness, great thirst, redness and swelling of the face and 
eyelids, distressing itching, and red or puffy blotches all over 
the body, like severe nettle-rash, convulsions, and sometimes 
death, in from three hours to three days. — Apjohn. 

WHAT TO DO. 
If the symptoms appear within an hour or so, an emetic 
should be given : if longer time has elapsed, a brisk purga- 
tive of Glauber's salts, and strong lemonade should be drank. 

POISONOUS BITES OF SERPENTS AND INSECTS. 
The only venomous serpents in this country are the adder 
or viper, moccoson and rattlesnake — the snake, slow worm. 



APPENDIX. 561 



and toad being harmless • our chief venomous insects are the 
bee, wasp, and hornet. 

Effects. — In the part wounded, a sharp tingling pain, is 
felt, which soon extends all around, with swelling, at first 
reddish and afterwards livid. In slight cases, this produces 
little constitutional derangement j in delicate children and 
females, and in severe cases, there are fever, sickness, nau- 
sea, vomiting, convulsions, and, sometimes, jaundice, dim- 
cult breathing, loss of sight, cold sweats, mortification of the 
wounded part, and death, sometimes lingering for several 
months, or even for years, with symptoms resembling con- 
sumption of the lungs. 

WHAT TO DO. 

If a cupping glass be at hand, it should be instantly ap- 
plied over the part, or it may be safely sucked by the mouth, 
and as much blood drawn as possible, to wash out the poi- 
son. If this be not done within a few minutes, the part 
should be burned with aquafortis, caustic potass, or a red hot 
iron, and afterwards covered with surgeon's lint, dipped in 
equal parts of sweet oil and hartshorn. A moderately tight 
bandage above (not over) the wound will tend to prevent the 
poison getting into the blood. It is important to encourage 
perspiration, by giving six or eight drops of ammonia, or 
hartshorn, in a glass of chamomile water, and by covering 
up the patient in a warm bed, and applying the bath. In 
slight stings of insects, salt water, or hartshorn and oil, may 
be applied, after the sting has been extracted by a needle. 
[For snake or spider bite, bleed and bathe, and if the pain 
continue, repeat the bath. — S. K. J.] 

HYDROPHOBIA FROM BITES OF MAD ANIMALS. 

Dogs are the most common causes of this frightful disease ; 
but it also may be caused by cats, pigs, or any other infected 
animal, chiefly in very hot or in very cold weather. 

Effects. — From the twentieth to the thirtieth, or fortieth 



36 



562 APPENDIX. 



day, sometimes even three or four months after the bite, the 
patient is seized with pain in the part, even if the wound be 
healed, with uneasy anxiety, languor, cramps, horror, dis- 
turbed sleep, and oppressed breathing. These symptoms 
rapidly increase with violent convulsions, hideous distortions 
of the face, swelling of the tongue, with clammy, virulent 
saliva, horror of fluids, (but not always,) with impossibility 
of drinking ; bilious vomiting and death. 

WHAT TO DO. 

As hydrophobia, when it once forms, is altogether incura- 
ble, every means of prevention should be tried. The bitten 
part should be immediately and fearlessly cut out to some 
extent, and cupping glasses instantly applied over the parts, 
to extract all the poison, if possible ; making still more sure, 
by bathing, with warm water, as long as blood will flow into 
the glasses. After this, a red hot iron, or any caustic, should 
be applied to the wound, and the whole covered with a car- 
rot poultice, and suffered to heal. Perspiration should be 
promoted by hot drink, and a warm bed. [Use the vapor 
bath— S. K. /.] 

Dogs, cattle, and other animals, when bitten, should have 
the bitten part treated in the same way. 



ACCIDENTS. 



APPARENT DEATH, SUSPENDED ANIMATION, OR ASPHYXIA. 
This class of accidents, from frequent occurrence, is ren- 
dered of little less importance than poisoning. 

APPARENT DEATH FROM CHARCOAL VAPOR AND CAR- 
BONIC ACID GAS. 

This may occur in close rooms where charcoal or coke is 
burning ; near lime kilns, from the reek ,* in coal pits, wells, 
and morasses, but most commonly in breweries and similar 
places, where much carbonic acid is produced by fermenting 
liquors ; and in very crowded rooms, from the breath of the 
people. It gives no warning, from being devoid of smell, 
and the air can only be tested by a candle, which will not 
burn in carbonic acid gas. 

Effects ichen breathed. — The first observed effects, are 
slight giddiness, and inclination to sleep ; but in severer 
cases, there is a sense of weight in the head, and soon, ster- 
torous breathing and death-like sleep. — Sir H. Davy. The 
person becomes, at length, motionless, with the limbs some- 
times stiff and distorted j at other times, easily bent. The 
heat of the body remains natural. 

What to do. — The first thing to be done, is to remove 
the person to the open air, and however cold the weather 
may be, to take off the clothes, laying him on his back, with 



564 APPENDIX. 



his head propped high. It is dangerous to fumigate with 
tobacco, or to place him in a warm bed. Cold water, or 
what is better, vinegar and water, dashed over the body, and 
towels, dipped in this, should be rubbed upon the face and 
chest, wiping dry the wetted parts in three or four minutes 
with hot towels : and repeating these processes more than 
once. If the patient can swallow, cold lemonade, or vinegar 
and water, should be given : hartshorn, or smelling salts, or 
sulphur matches, should be lighted and passed under the 
nostrils, which might also be irritated with a feather. Rub- 
bing the back, the soles of the feet, and palms of the hands, 
roughly with a brush, is also good. Blood, if it will flow, 
should be taken from the arm. from the jugular vein, or by 
cupping from the neck. — Apjohn. But by far the most im- 
portant remedy, is to keep up artificial breathing, by blowing 
into the lungs with a pair of common bellows ; with the 
mouth: or. what is better, with the double bellows, contin- 
uing this for five or six hours, even where there are no signs 
of lire. When the patient is once roused, he should be 
placed in a warm bed with the windows open : and may 
have a glass of good wine, or brandy, and he must be care- 
fully watched, lest he relapse. 

APPARENT DEATH FROM HYDROGEN GAS. 

vSulphuretted hydrogen gas is generated in common sew- 
ers, water closets, necessaries, foul pools and some mineral 
springs : and it is the cause oi a disgusting smell. Carbu- 
retted hydrogen gas. or coal gas. is the well known gas used 
for lighting our streets, but is not so deleterious as the 
former. 

Effects When breathed. — In slight cases, there are uneasi- 
ness, inclination to vomit, convulsive motions in the muscles 
of the joints and chest, cool skin, and irregular, but free 
breathing. In more serious cases, there is a loss ot sense 
and consciousness : the body is cold ; the lips and face, livid; 
a bloodv froth comes from the mouth ; the breathing is 



APPENDIX. 565 



short, oppressed, and convulsive ; and the limbs are relaxed. 
In still more dangerous cases, the body is bent backwards, 
and the patient bellows somewhat like a bull ; the heart pal- 
pitating irregularly and tumultuously. 

What to do. — In the first instance, expose the patient to 
the open air, dash cold vinegar and water over him, and rub 
the body as directed in cases of charcoal vapor. Then if 
chlorine can be had, it is important to pass the bottle con- 
taining it, cautiously under the nose. Bleed from the arm, 
or the jugular vein ; and this repeated, if necessary, will tend 
to allay the palpitation of the heart ; and the cold bath will 
be useful for cramps or convulsions, rubbing dry after it, and 
putting the patient in a warm bed. If there be no signs of 
life, mustard poultices, or boiling water, in bladders, may be 
applied to the soles of the feet, in order to produce immediate 
blisters. 

APPARENT DEATH FROM DROWNING. 

Effects. — When a person has been under water for about 
twenty minutes, more or less, there is little chance of recov- 
ery, though means should always be tried. The warmth of 
the body, and the clearness and motion of the pupils of the 
eyes, are the surest signs of life not being extinct, of which 
the stiffness of the body is chiefly to be relied on, as a sign 
of death. 

What should not be done.- — As it is not the water get- 
ting into the lungs, according to vulgar opinion, that causes 
death, but the want of air and stoppage of breathing, a 
drowned person ought not to be hung up by the feet to let 
out the water, little or none being swallowed. Violent sha- 
king, or rolling on casks, to rouse the patient, will also be 
dangerous ; as it also is to give tobacco, or the smoke of to- 
bacco, in form of enema or injection. The body must not 
be rubbed with salt nor spirits. 

What to do. — -With the least possible delay, even when 
the patient is received into a boat (Portal) — he should, with- 



566 APPENDIX. 



out jolting, be laid on his right side, on a plank or mattrass, 
with his head uncovered and a little raised ; the wet clothes 
must be quickly removed by cutting them open, the water 
let out from the mouth by opening the jaws : the body rub- 
bed dry; and then covered immediately with the spare 
clothes of the bystanders, till warm blankets be got ready, 
in which the patient is to be wrapped. 

It is important that the body be warmed very gradually, 
and the best thing for this purpose is a warm bath, about as 
hot as the hands can easily bear ; but in default of this, fill 
bladders with warm water, or heat bricks, and apply to the 
pit of the stomach, to the arm-pits, between the thighs, and 
to the soles of the feet, and the palms of the hands. Then 
pass backwards and forwards upon the skin, particularly 
along the back, a covered warming pan, a heated smoothing 
iron, or a bag filled with hot ashes. The skin ought also to 
be briskly rubbed all over, with the hand, or with a dry 
brush, or hot flannel, continuing the other means, just re- 
commended, at the same time. [Use our bath. — S. K. J.] 

It will tend to rouse the patient, to apply cautiously under 
the nostrils, lighted brimstone matches, smelling salts, or 
hartshorn, or to tickle the nose with a feather. In order to 
restore breathing, introduce the pipe of a common bellows 
(when a special apparatus is not at hand) into one nostril, 
carefully closing the other and the mouth. At the same 
time, draw downwards, and push gently backwards, the up- 
per part of the windpipe, popularly termed Adam's apple, to 
allow a more free admission of air : blow the bellows gently 
so as to inflate the lungs, till the breast be perceptibly raised 
a little. The stopping of the other nostril and the mouth, 
should then be discontinued, and the breast be pressed with 
the hand, repeating this so as to imitate the process of brea- 
thing, till life appears. — Humane Society's Directions. 

If the patient still remain insensible, small bits of cork, or 
paper, or of German tinder, should be burned on the pit of 



APPENDIX. 567 



the stomach, on the thighs, and on the arms. If the limbs 
be warm and easily bent, but the face livid or black, blood 
may be taken from the jugular vein, or from the foot ; but 
this need not be done when the skin is cold, and the limbs 
stiff. 

When there are signs of recovery, inject into the stomach, 
by means of an elastic tube and syringe, half a pint of warm 
wine and water, or good spirits and water ; and when the 
patient can swallow, a spoonful of wine or cologne water, 
diluted with two waters, or a teaspoonful of camphorated 
spirit, may be given every five or ten minutes, and he must 
be forced to drink so long as there remains difficulty of swal- 
lowing. 

It is important to continue the means for four, five, or 
more hours ; even eight or ten hours are very often not suffi- 
cient to establish recovery. 

APPARENT DEATH FROM STRANGLING OR HANGING. 

Effects. — From the return of the venous blood being stop- 
ped by the rope, &c. round the neck, the face is rendered 
black, the eyeballs stand out from their sockets, and the nos- 
trils are wider than in natural death. 

What to do. — After the rope, &c. has been removed, the 
taking of blood from the jugular vein is advisable, as well as 
all the other means directed under Drowning, except artifi- 
cially warming the body, which will, in most cases, be unne- 
cessary. The bellows may be considered the most important 
agent. 

CHOKING FROM ANY SUBSTANCE IN THE WINDPIPE. 

Every morsel that is swallowed, slides slowly over the top 
of the windpipe ; but is prevented from getting into it, by a 
sort of moveable lid, or valve, called the epiglottis, which the 
passing morsel shuts do^ii. But if a breath be drawn dur- 
ing the act of swallowing,\his lid is raised, and part of the 
morsel, or of the drink, may thus get under the lid. 



568 APPENDIX. 



CHOKING FROM ANY SUBSTANCE IN THE GULLET. 

If a splinter of bone, a pin, or the like, be accidentally 
swallowed, and stick in the gullet, it will- produce great un- 
easiness to the sufferer, though it may not be dangerous. 

What to do. — A plentiful draught of water, or twirling 
round a large goose or swan quill, will sometimes dislodge 
the substance, and make it fall down into the stomach, 
whence it may be brought up by vomiting. Even after it? 
removal, a roughness or soreness remains, which makes the 
sufferer think it is still there. When the substance is large 
and not far down, it may be extracted with a pair of forceps ; 
if it be too far down for that, it may be pushed into the sto- 
mach with a thin piece of whalebone, with a piece of sponge 
attached to the end of it, called a probang. — Mac Fayden. 

APPARENT DEATH FROM A STROKE OF LIGHTNING. 

The effects of lightning on the body are, general paleness 
of the surface, the limbs remaining warm and easily bent, 
long after life is extinct. 

What to do. — The only probable means of restoration, 
are galvanism or electricity, with the use of the bellows, and 
wine, as directed under Drowning. 

APPARENT DEATH FROM TOO GREAT HEAT. 

When a person becomes insensible, from being in too hot 
a place, he ought, without loss of time, to be removed into 
the fresh air, to be undressed, or, if very cold, his clothes 
loosened ; to have an enema, or injection of salt and water, 
with six to twelve leeches on the temples, and if he can 
swallow, a little vinegar and water, or lemonade, should be 
given. In other things, proceed as directed for Charcoal 
Vapor. 

APPARENT DEATH FROM TOO GREAT COLD. 

Effects. — Exposure to intense /^ld produces a general 
numbness, a sort of intoxication, irresistible and rather pleas- 
ing inclination to sleep, which soon comes on, with loss of 



APPENDIX. 569 



consciousness and insensibility, and from which the patient 
rarely awakens. 

What to do. — The body should, on rinding it, be wrapped 
in a blanket, leaving the head uncovered, till conveyed to a 
house, when the clothes must be taken off, and the skin rub- 
bed with snow, pounded ice, or cold water, rubbing from the 
body towards the extremities : to be succeeded by rubbing 
with cloths dipped in milk-warm water, it being important to 
restore warmth, not suddenly, but very gradually. When no 
snow nor ice is at hand, a cold bath ; very gradually heated, 
may be advisable. When the skin begins to feel warm, the 
sufferer may be put into a cold bed, and the bellows and 
other means used as under Drowning. 

FROST BITE, AND FROZEN LIMBS. 

Effects. — When the extremities, or any part of the body, 
is exposed to intense cold, the circulation of the blood, and 
the feelings of the nerves are destroyed, by the parts freezing. 

What to do. — If the frozen part is suddenly thawed by 
heat, speedy mortification comes on ; therefore, the best 
thing to do, is to restore warmth very slowly, by rubbing the 
part with snow, or ice water ; and at first, to give no heating 
or stimulant liquors internally; lying on a cold bed is good. 

APPARENT DEATH IN NEW-BORN INFANTS. 

In the absence of medical attendance, if the skin be pale 
and bloodless, the navel string must, on no account, be cut, 
nor twisted, nor dragged ; but the head should be raised, 
and the face exposed to the air, while the body is to be 
wrapped in flannel, and the back and the soles of the feet 
rubbed with a soft hand. Artificial breathing through a 
quill, or any small tube, should be tried, as directed under 
Drowning. 

On the other hand, if the face be livid, or black and 
swelled, the skin discolored, and the chest as if filled with 
blood, cut the navel string instantly, and encourage it to 



570 APPENDIX. 



bleed, by holding up the head and rubbing the chest and 
belly with warm cloths. Should little or no blood flow, ap- 
ply one or two leeches behind the ears, and put the sufferer 
in a warm bath, with which some wine, brandy, or vinegar, 
may be mixed : and use the quill for artificial breathing as 
just directed. 
INSECTS, SAND, AND OTHER SUBSTANCES IN THE EYES. 

If a grain of sand, an insect, or any small substance, get 
into the eye, it will produce irritation and inflammation, and 
may either cause dimness, or entire loss of sight. 

What to do. — When the substance lies loosely on the 
surface of the eye, it may be easily removed by means of a 
camel hair pencil dipt in oil : or, what is, for the most part, 
more easily procured, a bit of paper rolled into the size of a 
quill, and softened in the mouth. 

When the substance is fixed in the coats of the eye, an 
accident frequent among blacksmiths, and termed by them, 
fire in the eye, it may be removed by the thumb-nail, by 
the tongue, or by a blunt pointed piece of wood. If none of 
these are successful, application must be made to a surgeon. 

INSECTS, AND OTHER SUBSTANCES IN THE EAR. 

The opening into the outer ear, as far as the drum, is on- 
ly about half an inch, and is defended by a sort of down, as 
well as by a kind of soft wax. Among boys at school, bits 
of slate pencil, peas, and other things, sometimes get into the 
ear, and occasion much uneasiness. Bed bugs and other in- 
sects, also creep occasionally into the ear. 

What to do. — Peas, and such small substances, must be 
extracted by means of a pair of forceps. Insects may be kill- 
ed, by dropping in any sort of oil, such as oil of almonds, or 
sweet oil. 

ACCIDENTAL BURNING OR SCALDING. 

Burns or scalds may either be trifling or serious, and even 
dangerous, according to their extent, or to the constitution of 
the patient. Young children, or infants, seldom recover 



APPENDIX. 571 



from such accidents, when of much extent, for their skin is 
so tender, that a common medical blister heals with difficul- 
ty, if at all. 

Burns or Scalds of small extent. — The danger lies chiefly 
in the extent of the portion of the skin injured ; for a deep 
burn of small extent, may not be dangerous ; while a super- 
ficial scald, of considerable extent, may prove fatal. — &. 
Cooper. 

What to do. — The part injured should be plunged, or 
bathed in pounded ice, or very cold water, mixed with some 
quick-lime, or sugar of lead, renewing it as soon as it be- 
comes warm, and continuing the application till the pain is 
subdued, when it may be wrapped up in bandages, dipt in 
lime water, or sugar of lead water. — Sir J. Earle. The 
blisters, if any, should not be broken for two or three days, 
lest the pain should be increased, nor delayed longer, lest ul- 
cers might form ; at that time, they may be opened with a 
needle, to let out their serous fluid or water, and dressed with 
cerate, spread on linen, keeping down inflammation by bath- 
ing with sugar of lead water, and if that be not effectual, 
apply a linseed or other poultice. When the pain is distress- 
ing, so that the weight of the dressing is insupportable, the 
part should be annointed by a camel-hair pencil, with Carron 
oil, made with equal parts of linseed, or sweet oil, and of lime 
water, shaken together. The patient should be kept on low 
diet, and have a brisk dose of salts and senna. When ulcers 
form, they should be dressed with creasote ointment, to pre- 
vent scars. 

DEEP BURNS. 

When the burn is deep, the surface will appear to be 
scorched, as if charred, with more or less inflammation a- 
round it. 

What to do. — The best application, in this case, will be 
a linseed, or other poultice, smeared with camphorated oil, 
if it can be borne ; and if not, it should be dressed with ce- 



572 APPENDIX 

rate, till the charred portion comes off, when it must be dress- 
ed, twice a day, with surgeon's lint, on which is spread some 
crease ointment. This will tend to prevent a scar. Oily 
salves are improper. 

EXTENSIVE BURNS, OR SCALDS. 

If a burn or scald, though not deep, be spread over a con- 
siderable surface of the body, the accident is dangerous, and 
may become fatal. The accompanying pains are excruciat- 
ing, and the consequent fever and inflammation usually run 
high. 

What to do. — The application of cold, which answers in 
non-extensive cases, is apt to cause shivering, to hasten fe- 
verishness ; and though it ease the pain for a time, this soon 
returns with increased severity. Instead of cold applications 
therefore, repeatedly bathe the injured parts with linen cloths, 
dipt in warm spirit of turpentine, or spirit of wine, whether 
the skin be blistered or not, and afterwards dress with 
a cerate, made with one part of oil of turpentine, and two 
parts of basilicon ointment, spread on linen. The smarting 
pain caused by this, at first goes off in an hour or two, and 
much ease is felt. This dressing must be renewed in twen- 
ty-four hours, by small portions at a time, to prevent expos- 
ing the sore to the air, while all blisters may be opened with 
a needle. The parts should be bathed with common spirits, 
with vinegar, or with laudanum slightly warmed, and dress- 
ed with Turner's cerate, or sugar of lead ointment. -Ken tish. 
If there be much inflammation, a warm linseed poultice will 
be advisable, to remain on for six or eight hours, and if the 
surface be raw, it may be entirely covered with finely pow- 
dered chalk, in order to absorb all moisture, and the poultice 
may be applied over this. — C leghorn. 

RUFFLED SKIN, OR ABRASION. 

When the thin, insensible scarf skin is accidentally des- 
troyed, the inner and thicker skin, which is very sensible. 



APPENDIX. 573 



on exposure to air, is irritated, and rendered painful by the 
oxygen in the air acting on the fine tips of the nerves. 

What to do. — All sand and dirt should first be removed 
from the injured part, by means of warm water, and linen 
dipt in spirits and water, should be applied, till the pain is 
somewhat subdued. The parts ought then to be defended 
from the air, by a piece of dry surgeon's lint, or caddice, and 
a poultice should be laid over it, if there be much inflamma- 
tion, or swelling. If a sore of any size should form, it may 
be dressed with creasote ointment, to prevent a scar. 
CHAFED SKIN, OR EXCORIATION. 

If the skin be galled by riding, or, in infancy, by inatten- 
tion to cleanliness, it ought to be bathed with warm milk and 
water, to clean it ; and afterwards with cold water, to wash 
off the milk and remove inflammation. Fine Fuller's earth, 
moistened with water, or spermaceti ointment, is good for an- 
ointing the parts. If there be much pain, a bread and water 
poultice may be advantageous. — Hamilton. Dust the part 
with lapis calaminaris. — & K. J. 

CUTS AND WOUNDS. 

The danger of cuts or wounds may be partly inferred from 
the parts injured ; wounds in the belly, for example, being 
more dangerous than in the limbs ; and an inference may al- 
be drawn from the bleeding. When a large vein has been 
cut, the blood will come away of a dark color, and a contin- 
ued stream ; when a large artery is cut, the blood will come 
in pulse-like jets, and of a bright crimson color. 

What to do. — In slight cases, let the bleeding continue 
for an hour, if it do not stop sooner, taking care to remove 
all dirt, or other matter, that may have got into the wound. 
When the bleeding ceases, bring the edges of the wound 
neatly together, and keep them so with slips of heated stick- 
ing plaster, and do not remove this for two or three days, 
when it will usually be found healed. If it inflame, it must 
be poulticed. In slight cases, salves are now disused by all 



O i 4 APPENDIX. 



good surgeons, as worse than useless. In severe and alarm- 
ing cases, little can be done without a surgeon ; but when 
dark venous blood flows, strong pressure a little below the 
part will tend to stop it : and when bright arterial blood jets 
out, similar strong pressure a little above may do good : cov- 
ering the part with cloths will only conceal the danger. Cold 
water, or turpentine, or Friar's balsam, may tend to stop the 
bleeding, perhaps ; but not when large vessels have been cut. 
A strong silk handkerchief, twisted tight on the limb, below 
or above the injured part, according as the blood is dark or 
bright, may often be advisable. — MacFayden. "When the 
bleeding has been stopt, the edges of the wound are to be 
brought together, and treated just as directed for slight cases, 
using bandages when the sticking plaster is not strong enough. 
If it becomes inflamed use dry heat — a shovel of coals. 

BRUISE.S. 

In all bruises, the nerves are affected, causing a sort of 
stunning pain. Swelling and discoloration are caused by 
blood vessels, small or great, being burst, and the blood be- 
ing effused around, particularly when the bones are near the 
surface, as on the shins and the head. Inflammation of the 
injured parts generally follows in an hour or more. 

What to do. — In slight cases, bathe the parts with vine- 
gar and water, or spirits and water. In severe cases, particu- 
larly near the joints, it is important to prevent inflammation, 
which might lead to white swelling, &c For this purpose 
a dozen or more leeches should be applied. Then use dry 
heat — bleed and use heat intensely. — S. K. J. 

SPRAINS. 
When the ligaments of the ancle, of the wrist, or of other 
parts, are twisted, or over-stretched, there are produced weak- 
ness, and more or less pain, which increases with the conse- 
quent inflammation. The parts swell and become tense, red, 
and warmer than natural. If neglected, or if the sufferer is 



APPENDIX. 575 



of a particular constitution, sprains may end in white swel- 
ling, or incurable lameness. 

What to do. — The sooner the better, bathe the part with 
three parts of cold water, mixed with one part of laudanum, 
and one part of any common spirits ; and bind up the limb 
with a moderately tight bandage, and laying it horizontally, 
in a state of absolute rest. If inflammation do come on, 
bleed and apply dry heat with a shovel of burning coals. — &. 
K. J. Those who know how difficult it is to get rid of even 
trifling sprains, will not think this too severe treatment. 

BONES BROKEN OR FRACTURED. 

When a limb has been broken, there is not only a loss of 
motion, as when out of joint, but more or less distortion and 
swelling, while the broken ends of the bones may, by hand- 
ling, be made to produce a grating sound. 

The best advice, in this case, is to get a surgeon as soon as 
possible, or remove the sufferer, on a board, to an hospital. 
If neither can be done, the injured limb must not, on moving, 
be allowed to hang down. The limb is set by bringing the 
broken ends of the bones together, and keeping them in their 
place with splints and bandages. If they be displaced, the 
limb will heal in a distorted form. The bones generally 
unite in from thirty to forty days, and sooner in the young 
than in the old. When inflammation occurs, it must be treat- 
ed as directed under Sprains. 

LIMBS OUT OF JOINT, OR DISLOCATED. 

When the head of a bone is dislodged from its socket, the 
form of the joint is changed, the limb cannot be moved, and 
it is rendered sometimes longer, and sometimes shorter. 

What to do. — Delay here is productive of the worst con- 
sequences ; for, at first, it is comparatively easy, though after 
a while, sometimes impossible, to replace the bone. Great 
force is often necessary to draw the limb out far enough to 



576 APPENDIX. 

get the head of the bone over the edge of the socket, but it 
can rarely be done without surgical aid. 

A FAINTING FIT, OR SYNCOPE. 

In consequence of exhaustion from fatigue, long fasting, 
violent passion, severe pain, wind in the stomach, and the 
like, the patient grows deadly pale, and is deprived of sen- 
sibility, the eyes become dim, the hearing is gone, the pulse 
stops, breathing is imperfect, and the voice is lost. The fit 
seldom lasts beyond a few minutes, bat leaves the patient 
languid or sick. 

What to do. — The coming on of a fainting fit may be 
sometimes prevented by drinking a glass of cold water, or 
wine. When it takes place, throw open the windows, sprin- 
kle cold water on the face, and cautiously hold smelling salts, 
or a lighted brimstone match, under the nostrils. On reviv- 
ing, a glass of water or wine will be advantageous. 

CONVULSIVE FITS. 

Infants and children are very subject to convulsive fits, 
from teething or disordered bowels, and sometimes from wa- 
ter in the head, hooping cough, &c. When dangerous, the 
body is often bent back, the features distorted, and the eye 
fixed or rolling. A fit may continue from a few minutes to 
several hours. 

What to do. — As the fit may end in death, the child 
should, without delay, be put into a warm or cold . bath ; till 
it go off, and cold water should be sprinkled on the face. 
When the fit continues long, apply two or three leeches to 
the temples, and give a laxative enema, or injection. [We 
say let it be bled. — &. K. J.] 

HYSTERIC FITS. 

Before the fit oomes on, there is a feeling as if a ball were 

rising in the throat, threatening suffocation, and the sufferer 

soon falls down, the body being twisted, the hands clenched, 

while the person rolls about, screaming, crying, or laughing 



APPENDIX. 577 



involuntarily. As the fit goes off, the patient remains for a 
time stupid, and half insensible. 

What to do. — The fit may sometimes be prevented by 
taking twenty or thirty drops of laudanum, and as many of 
ether, in a glass of water. Open the windows, and loosen 
the tight parts of the dress ; sprinkle cold water on the face. 
If the patient be of a full habit, let blood. 
A FIT OF APOPLEXY. 

Apoplexy is caused by too much blood pressing on the 
brain. Sometimes the person falls down suddenly ; at other 
times, there is previously violent head-ache, high fever, and 
delirium. 

What to do. — In this case it will be dangerous to apply 
lighted brimstone matches, or smelling salts to the nostrils : 
or to introduce wine or other strong liquor into the stomach, 
as directed for Fainting or Hysterics. The patient should 
be placed in an upright posture, supporting his head to pre- 
vent any bend in the neck, while the neckcloth must be re- 
moved, and the shirt collar unbuttoned. Bleeding is often 
important, but must depend on medical advice. 

FITS OF FALLING SICKNESS, OR EPILEPSY. 

This more resembles a fit of hysterics, and is often brought 
on by drinking, by violent passions, &c. An attempt to 
feign epileptic fits, may readily be detected by feeling the 
pulse, which is suspended or very irregular in genuine epi- 
lepsy; in which also there is frothing at the mouth, imitated, 
however, by means of soap. 

What to do. — Raise his head, and put a piece of soft 
wood or cork of suitable size, if possible, between the teeth, 
to prevent his biting his tongue. Then proceed as for Hys- 
terics. 



37 



MEDICAL PRESCRIPTION. 



CATHARTIC, OR ANTI-BILIOUS PILLS. 



Take aloes, (socotrine,) dr. i. 

powdered jalap. dr. i. 

calomel, dr. i. 



castile soap, dr. i. 

gambouge, gr. xv. 



Scrape or powder the soap very finely ; add half a small tea- 
spoonfull of water, mix the mass well. The whole will make 
sixty pills. As each pill will contain one grain of calomel, the 
dose may vary from one to six, as the occasion may require. 

ANOTHER FORM OF ANTLBILIOUS PILLS. 

Gambouge, gr. xx. 

Calomel, dr. i. 



Compound extract of Colocynth, dr. i. 
Powdered jalap, dr. i. 

Castile soap, dr. i. 

Prepared as the Cathartic Pill. Dose the same. 

THE MINIMA PILL. 

Take Calomel, gr. v. | Ipecacuanha, gr. v. 

Crumb of corn or wheat bread, size of a large pea. 

Work them well together, and the mass will make 25 pills. 

One is the dose, to be repeated once, twice, or three times a 

day. If continued too long, may produce a sore mouth. 

COMPOUND BLUE PILL. 



Take blue mass, dr. i. 

rheubarb, powdered, dr. i. 

aloes, powdered, dr. i. 



castile soap, dr. i. 

ipecacuanha, gr. xv. 

water, about forty drops, or q. s. 



Work the materials well together ; the mass will make sixty 
pills ; the dose, one, two, three, or four. They will be gent- 
ly aperient. 

ANODINE ALTERATIVE PILL. 

Tale calomel, gr. vi.; ipecacuanha, gr. vi.; Opium, gr. iv. — make 25 pills. 

ANTI-BILIOUS PILLS 
Made of calomel and ipecacuanha, one grain of each to a pill, 



APPENDIX. 579 



and repeated every third hour, will operate very gently. If 
made of three or five grains each, and repeated in the same 
manner, they operate with sufficient effect for the first day or 
two in a case of fever, on its first attack. This for an adult 
patient. Similar pills of half grains of calomel and ipecacu- 
anha, will be suitable for children of two, three, or four years 
old. The same articles in doses of a fourth of a grain each, 
will suit children six months old, and in doses of one-third 
of a grain each, will suit for children one to two years old. 

PILLS FOR EPILEPTIC FITS. 
Take of the powdered leaves of stramonium, which is the 
thorn-apple of the North, and the Jamestown weed of the 
South. It ought to be gathered in the last week of August, 
and dried in the shade. Of the powdered leaves of this herb, 
take one dram, work it up with molasses and make it into 
thirty pills, of which give three or four per day. When his 
pulse is tense near the time of an expected return of the fit, 
let him be bled, about mid-day; and as often as his pulse is 
tense about that time, repeat the blood-letting. Let his bow- 
els be regulated by using the cathartic pills. 

PILLS TO BE USED IN A CASE OF ABORTION. 
Take calomel, gr. x. Opium, gr. vi. 
Make three pills. If there be much fever, with or without 
a pain in the head, let the patient be bled one pint, or one 
pint and a half, according to her strength ; then give one 
pill every sixth hour, till she is easy, or drops the foetus or 
ovum. In the meantime, use the bath. 

FOR A SOUR STOMACH IN GESTATION. 
Take supercarbouate of soda, dr. i.; Rhubarb, gr. xxx.; Oil Cloves, drops iii. 
Give one-sixth of the preparation, every second hour, in two 
table spoonsful of sweetened water, until it affords relief. 

SYRUP OF PHYTOLACCA DECANDRA. 
Take of the fresh root of phytolacca decandra, (poke root) 
dug in August or September, ten pounds, chopped into small 
pieces, boil it in ten pounds of water, till quite soft, then 



5S0 APPENDIX 



strain and squeeze the root, so as to obtain the whole of its 
virtues. Let it stand till the sediment shall be fairly precip- 
itated. Carefull y decant and measure the decoction. Then 
put it on the fire and evaporate, till it is reduced to five quarts. 
At this stage, add ten pounds of brown sugar, and keep it on 
a slow fire, till reduced again to five quarts, when it will be 
fit for use. Of this syrup, a large teaspoonful is the dose, to 
be repeated three or four times a day. 

It will be important, in treating scrofulous ulcers, scrofu- 
lous tumors, secondary syphilis, mercurial diseases, heredi- 
tary syphilitic taint as it exists when it befalls scrofulous sub- 
jects, especially as this condition of things is exhibited, in 
that formidable affection, known in some parts of Virginia, 
by the appellation of the yaws. We often associate with this 
syrup, the hydriodate of potash. With or without this addi- 
tion, it is very useful also in cases of chronic rheumatism. 

N. B. When the root is dug, let it be immediately washed 
and chopped to pieces. Let it remain one day, and then 
weigh it. If it remain a day or two before it is boiled, it 
matters not. But the weight as found the second day, is to 
guide the preparation. 

COMPOUND CHALK MIXTURE FOR DIARRHCEA. 



Loaf Sugar. 


oz. i. 


Pulverized Gum Opium, 


gr. vi 


Prepared Chalk, 


dr. \l. 


Oil of Cloves. 


drops vi. 


Pulverized Gum Arabic, 


dr. ii. 


Oil of Pepper, 


drops xii. 



Grind the above together ; then add tincture of kino, oz. i. 

ss., and water, oz. vi. ss. Dose, a teaspoonful every hour till 

the intended effect is produced. 

Remedy for Thrush. — Take equal parts of sweet oil and 

Jime water, well shaken together. 

DETERSIVE SOLUTION FOR FISTULOUS ULCERS. WITH OR 
WITHOUT CARIES. 



Salt, 
Honey, 

This to be used as an injection or wash. 



lb. ss. 


Vinesfar, 


oz. iv 


oz. iv. 


Corrosive Sublimate. 


gr. xx. to xxx 


oz. iv. 


Water, 


lb.; 



APPENDIX. 581 



A VERY NEAT BLISTERING OINTMENT. 

Take tallow, oz. vii. I bees-wax, oz. iii. 

hogs lard, oz. ii. | resin, oz. ii. 

Melt them together, stirring them effectually. Take the pre- 
paration off the fire, to reduce the temperature a little, then 
add two ounces and a half of Spanish flies, very finely pow- 
dered, and stir till the ointment is cold. 

PLUMBEAN OINTMENT. 

Take red lead, oz. xx. J Linseed oil, two quarts. 

These are to be put in to an earthen vessel, (which must be a 
new one every time the ointment is made,) and placed on a 
slow fire, out of doors, and boiled until it becomes brown, 
stirring all the time. 

Useful as a plaster for scattering the swelling of an inflam- 
ed breast, after child-birth ; first letting blood, or giving a 
gentle cathartic. It may be spread on a thin cotton cloth, of 
a suitable shape, &c, and removed every six hours for the 
purpose of using a shovel of hot coals, as advised in any case 
of pain and swelling. A camphor plaster would answer 
when this is not at hand. It is also useful for burns and old 
sores. Let it remain in the crock, and keep it covered with 
water. 

ERUGINOUS OINTMENT. 

Take fresh butter or lard, lb. i. I Bees-wax, oz. ii. 

Burgundy pitch, oz. iv. | Verdigris chrystalized, oz. ss. 

Melt these well together, and when beginning to cool, add 
red precipitate, oz. i. ss. (ground to the greatest possible fine- 
ness,) and oil of juniper, oz. ss. Let the composition be faith- 
fully stirred till it is cold. 

Useful for scald head, tetters, &c. Wash and soak off the 
crusts and scabs, and apply the ointment with the finger, rub- 
bing it in well. Repeating once or twice every day. 



582 



APPENDIX. 



A PATIENT RECEIVING AN APPLICATION OF 

JENNINGS' PATENT VAPOR BATH, 




Fig. 1. The tubular stove, for directing the heated air into the hollow- 
space made by placing the frame, covered with three or four blankets, over 
the patient. 

Fig. 2. The cups, one of which is filled with alcohol, or spirit of good 
proof, placed in the stove, and set on fire with a blaze. 

Fig. 3. The frame uncovered for inspection. 

Note. — If the patient be sponged all over with diluted sulphuric acid, (oil 
of vitriol,) say two or three drams to a pint of warm water, immediately be- 
fore applying the heated air, it will be equal to a sulphuric bath, and will 
cure the itch, and some other affections of the skin. It may be necessary 
sometimes to repeat the application. 



GLOSSARY. 



As it is probable that this book may be purchased for family reference, 
the author has added a Glossary of the technical terms used in the work. 



ABDOMEN, the belly, or paunch. 

Abdominal, pertaining to the abdomen. 

Adipose, fat. 

Anasarcous, dropsical. 

Anastomose, the communication of vea- 

g sels with each other. 

Anginose affections, inflammatory af- 

s = fections of the throat. 

Anormal, irregular, unnatural. 

Anthelmintic, having the power of des- 
troying worms. 

Antiphlogistics, medicines that reduce 
^ fever and inflammation. 

Antispasmodics, medicines that allay 
spasms, or cramps. 

Aperients, medicines that gently open 
the bowels. 

Aphorism, a precept, a detached sem 
tence containing an important truth. 

Aphtha, small superficial ulcers in the 
mouth. [agues 

Apyrexia, the period of intermission in 

Arachnoid, the middle membrane cov- 
ering the brain. 

Ardor urincB, a scalding of urine. 

Arthritis, rheumatic pains of the joints. 

Asphyxia, apparent death, suspended 
animation. 

Asthenia, diminished vital energy. 

Asthenic, the same. 

Axilla, the arm pit. 

Axungia, hog's lard. 

Belladonna, deadly night shade. 

Blennorhosa, a morbid secretion of mucus 

Borborygmus, rumbling produced by 
wind in the bowels. 

Bronchia, the air tubes in the lungs. 

Bronchotomy, an incision into the wind- 
pipe. 

Bulimia, insatiable craving for food. 



Cachexia, a generally weak, relaxed and 
disordered state, without fever. 

Canthus, angle of the eye. 

Capillary vessels — Capillaries, the very 
minute vessels, between the arteries 
and veins. 

Cardia, the upper orifice of the stomach. 

Cardiac region, the pit of the stomach. 

Caries, an ulcerated bone. 

Carotids, the arteries that convey the 
blood to the head. [males. 

Catamenia, the monthly discharge of fe- 

Cataplasm, a poultice. 

Catenation, a chain of morbid actions. 

Catheter, a hollow tube for drawing off 
the urine. 

Cellular membrane, or tissue, the filmy 
meshes which connect the minute 
component parts of most of the struc- 
tures of the body. 

Cephalalgia, head-ache. 

Cephalic, relating to the head. 

Cerebral, relating to the brain. 

Cerebrum, the brain. [in the neck. 

Cervical vertibrce, the joints of the spine 

Cervix uteri, neck of the uterus. 

Chyle, the milky fluid produced by di- 
gestion. 

Chyme, the food after it has undergone 
the process of digestion in the stomach, 
and has passed into the bowels. 

Colliquative stools, profuse, watery dis- 
charges from the bowels. 

Collyrium, an eye wash. 

Coma, profound lethargic stupor or sleep. 

Comatose, morbidly sleepy, [in a part. 

Congestion, the accumulation of blood 

Conjunctiva, the mueous membrane 
which lines the posterior surface of 
the eye-lids, and is continued over the 
forepart of the globe of the eye. 



584 



GLOSSARY. 



Constipation, costiveness. 

Crassamentum, the red globules of the 
blood, collected in a mass with the 
coagulable lymph. 
D 

Dejections, alvine, evacuations by the 

Deliquium, fainting. [bowels 

Demulcents, soothing, mucillaginous 
fluids, as flax-seed tea. 

Dentition, teething. 

Derivatives, remediate applications, that 
draw the blood from an affected part 

Desquamation, scaling off, or separation 
of the skin in small scales. 

Diagnosis, the distinguishing marks of 
particular diseases. 

Diaphoresis, gentle perspiration. 

Diaphragm, the muscular partition be 
tween the chest and abdomen. 

Diathesis, any particular diposition, or 
habitude of the body. [the diet 

Dietetic, relating to the regulation of 

Diluents, bland drinks. 

Diuretics, medicines that increase the 
flow of urine. 

Duodenum, the first twelve inches of the 
small intestines. 

Dyspnoea, oppressed breathing, [urine 

Dysuria, difficulty and pain in passing 
E 

Ecchymosis, blood seen under the skin. 

Eclampsia, convulsions in child-bed. 

Effluvia, exhalations, vapors, &c. 

Ejections, discharges from the stomach 
by vomiting. 

Electuary, a compound medicine, made 
into the consistence of honey. 

Emesis, vomiting. 

Emetic, a medicine that causes vomiting 

Emulsion, a milk-like fluid, formed by 
mixing oily or resinous substances, by 
means of mucilage, with water 

Encephalic, relating to the cavity of the 
skull. 

Encephalon, the brain with its mem- 
branes. 

Endemic, a disease peculiar, or especial- 
ly prevalent, in certain localities or 
districts. 

Endennic, a term signifying an applica- 
tion of medicine to the skin, 

Enema, a clyster, an injection. 

Enemata, injections. 

Engorgement, an accumulation and 
stagnation of fluids in a part. 

Epidermis, the outer skin. 

Epilepsy, fits, or falling sickness. 

Epispastics, [substances that blister the 
skin, as Spanish flies. 



Epistaxis, bleeding from the nose. 

Errhines, substances used to produce 
sneezing. 

Error toci, an error of place, the pulse is 
sometimes found out of place. 

Erysipelas, St. Anthony's fire. 

Erythema, a slight inflammation of the 
skin. [applying caustic, &c. 

Eschar, the dead substance produced by 

Etiology, relating to the causes and ori- 
gin of diseases. [a»fever. 

Exacerbation, the period of increase of 

Exanthemata, acute eruptive diseases. 

Ecitability , the capacity of being excit- 
ed by stimuli. 

Excitement, the action caused by stimuli. 

Exfoliate, to cast, or scale off, as the 
skin, or a piece of dead bone. 

Expectorants, medicines that promote 
spitting. 

Farinaceous, made of meal. 

Fascia, & tendinous expansion. 

Fauces, the posterior part of the mouth, 
or top of the throat. 

Febrific, that which causes fever. 

Febrifuge, a medicine that has the pow- 
er of arresting the progress of an in- 
termitting fever ; as bark. 

Febrile, feverish. 

Femoral artery, the artery felt in the groin 

Filamentous, thread-like. 

Fistula, a deep, tube-like ulcer. 

Foramen, an opening, or hole. 

Function, the action, or office performed 
by an organ. 

G 

Ganglion, a small knot, or roundish en- 
largement of a nerve or tendon. 

Gangrene, mortification. 

Gastralgia, pains in the stomach, with- 
out fever. 

Gastric, relating to the stomach. 

Gastritis, inflammation of the stomach. 

Gastro enteritis, inflammation of the 
stomach and bowels. 

Gestation, the act of bearing the young 
in the womb. 

Globus hystericus,^ feeling like a ball 
rising from the stomach to the throat. 

H(cmatemesis, vemiting of blood. 

Hematuria, voiding bloody urine. 

Hirmopthysis, bleeding from the lungs. 

Hemorrhage, bleeding from any part of 

Hemorrhoids, piles. [the body. 

Hectic, a slow habitual fever, with sweats 
and emaciation ; accompanies con- 
sumption. 



GLOSSARY. 



585 



Hemicrania, pain on one sidejof the head 

Hemiplegia, palsy on one side. 

Hepatization, change of structure, so as 
to resemble the substance of the liver 

Hernia, a rupture. 

" Humoralis, swelled testicles. 

Herpetic, having the character of a tetter 

Humoral, relating to the fluids, particu- 
larly the blood. 

Hydragogue, a purge that produces wa- 
tery stools. 

Hydrocephalus, dropsy in the head. 

Hydropic, dropsical. 

Hydrophobia, dread of water, difficulty 
of drinking. 

Hygiene, the preservation of health, that 
part of medicine which regards the 
preservation of health. 

Hyper car thar sis, excessive purgation 

Hyper-trophy, an unnatural enlargement 
of an organ. 

Hypocondriasis, hyp, low spirits. 

Hypothesis, a system or doctrine found- 
ed on a theory. 

I 

Icterode, yellow, jaundice-like. 

Icterus, jaundice. 

Idiopathic, an original affection of a part 

Idiosyncracy, any peculiar habit, [tines. 

Ileum, the lower part of the small intes- 

Iliac regions, the flanks, the lateral and 
lower parts of the abdomen. 

Inosculation, the union of tubular vessels 

Integuments, the skin, &c. 

Irritability, the capacity of being excit- 
ed into action. 

Ischuria, difficulty or stoppage of urine. 
L 

Lactation, the act of suckling. 

Lamellar, disposed in thin plates. 

Languor, faintness. 

Lateritious, like brickdust, brick-colored 

Leucorrhoza, the whites. 

Liniment, a very thin ointment. 

Lochia, the discharge from the womb 
after child-birth. 

Lumbago, rheumatism in the loins 
Lymphatics, vessels that carry white 
fluids. 

M 

Malaria, pestiferous exhalations from 
marshes and putrifying substances. 

Meninges, the coverings of the brain. 
Meningitis, inflammation of the cover 

ings of the brain. 
Metastasis, a translation of a disease 

from one part to another. 
Miasm, the same as malaria. [tion \Pharynx, the opening to the gullet. 

Modus operandi, the manner of opera [Phenomina, any perceptible change 



Morbific, capable of causing diseases. 
N 

Narcotic, medicines that blunt the sen- 
sibility of the nerves. 

Nates, the hips of the child. 

Nephritic, affections of the kidneys. 

Niuralgia, painful affections of a nerve, 

Normal, natural, healthy. 

Nosology, a systematic arrangement, 
explanation and definitton of diseases. 
O 

(Edema, swelling from a dropsical col. 
lection in the cellular membrane. 

(Esophagus, the gullet. 

Olfactory, relating to the sense of smelling 

Ophthalmia, inflammation of the eyes. 

Opiate, a medicine whose prominent in- 
gredient is opium. 

Organic affection, a disease in which 
more or less of the substance of a part 
is changed or disordered. 

Organism, the peculiar structure of a sin- 
gle organ. 

Organization, a system composed of 
several individual parts. 

Ossified, changed into a bony structure. 

Os uteri, mouth of the womb ; sometimes 
called as tinea, or externum, the ex- 
ternal opening to the uterus. 
P 

Paralysis, palsy. [gans. 

Parenchyma, the proper substance of or- 

Paroxysm, a periodical exacerbation. 

Parturition, labour, or child-birth. 

Patechia, spots like flea-bites, sometimes 
purple when there is danger. 

Pa£/iog-nomora'c,characteristic symptoms 

Pathology, doctrine of the causes and na- 
ture of diseases ; lately, this term has 
been not very properly applied to the 
diseased appearances discovered on 
dissection. 

Pectoral, relating to the breast. 

Pectoriloquism, a peculiar sound in the 
lungs when the patient speaks, heard 
through the sides of the chest by the 
stethescope. 

Percussion, striking the breast with the 
extremities of the fingers to ascertain 
the kind of sound produced. 

Pericardium, the membranous sack sur- 
rounding the heart. 

Peristaltic motion, the vermicular mo- 
tion by which the bowels push forward 
thf ir contents. 

Pharmaceutic, relating to the compound- 
ing, &c. of medicines. 



5S6 



GLOSSARY. 



which takes place in an organ or func- 
tion any remarkable or unexpected oc- 
currence. 

Phlegmasia, inflammation. 

Phlegmonous, inflammatory. 

Phlogosis, superficial inflammation. 

Phymosis, contraction of the foreskin, so 
as to prevent it being drawn back. 

Plethora, fulness of blood. 

Pleuritic, of the character of pleurisy, at- 
tended with pain in the side of the chest 

Pleurodynia, a pain in the breast with- 
out inflammation. 

Pneumonia typhoides, inflammation of 
the lungs of a low and dangerous type. 

Post mortem, after death. 

Prolapsus, a falling down. 

Prophylactic, any means employed for 
the preservation of health. 

Prostate gland, a gland situate at the 
neck of the bladder. 

Ptyalism, salivation. 

Pulmonary, relating to the lunrrs. 

Puruloid, resembling pus or matter. 

Pus, the yellowish thick fluid or matter 
formed by inflammation. 

Pylorus, the lower orifice of the stomach 

Pyrexia, fever. 

Pyrosis, water brash, or the heart-burn 

Quartan, a periodical disease returning 

every seventy-two hours. [daily. 

Quotidian, daily ; an ague that returns 

R 

Rachialgia, colic, with costiveness and 
Rachitis, rickets. [vomiiin- 

jRarj'oHfl/e.explanationofthe manner how 
Rete mucosum, the mucous-like exp in- 
sion immediately under the skm, and 



rate a peculiar fluid or substance from 
the blood. [actions of the system. 

Sedatives, medicines that diminish the 

Semicupium, warm bath, the body be- 
ing immersed only up to the middle. 

Sensorial power, an influence produced 
by the brain and nerves, by which they 
govern and sustain voluntary and vas- 
cular action. [tre of feeling. 

Sensorium commune, the brain, the cen- 

Serous, watery. 

Spicules, pointed like darts. 

Sthenic, a condition of the system having 
more than ordinary power. 

Strumous, scrofulous. 

Subsultus tendinum, a convulsive, sud- 
den twitching of the sinews. 

Sui generis, two Latin words, meaning 
of its own sort, or in its own way. 

Sympathetic nerve and ganglia, this 
structure extends frcm the head inside 
of the body, down by the back bones, 
to the lowest extremity of them. 

Symptomatic, the consequence of some 

Syncope, fainting, [other affection. 

Synochal, fever of a highly inflammato- 
ry character. [character. 

Synochus, fever of a sub-inflammatory 

Systole, in anatomy, the contraction of 
heart for expelling the blood, and car- 
rying on the circulation. 
T 

Tarsus, the edge of the eye-lid. 

Temporal artery, the artery at the temple 

Tenesmus, an ineffectual and painful 
urging to go to stool. 

Tetanus, lock-jaw. 

Therapeutic, relating to the employment 
of remedies. 

Thoracic, belonging to the chest. 



in which the coloring matter, that con 
stitutesthe color of the surface is depo-j ThorGx, the chest 
sited. [sures of the skin. 1 , Tormina, griping pains 

Rhagades, chaps in the skin, deep fis- Tubercles, small, hard tumours, resem 



Rigors, convulsive trembling 
Rubefacients, external applications that 
inflame the skin. 
S 
Sanguiferous, conveying the blood. 
Sanguineous, bloody, relating to blood 



bhng cheese in their internal structure. 

Type, the peculiar form assumed by a 
fever as to the period intervening be- 
twecn its paroxysms or exacerbations. 

Typhoid, resembling typhous fever. 



Schneiderian membrane, lining of the Ureters, the tubes which convey the 

nose, ic. [tion of a gland. j urine from the kidneys to the bladder. 

Seirrhus,a hard, degenerated tumefac- Urethra, the canal of the penis through 

Scybalte, hardened masses of excrement which the urine is discharged. 



detained in the colon. 
Sebaceous, suet-like matter. 
Secretion, the separation of a fluid or 

substance from the blood by the actior. 

of a living organ. 
Seci-etory, vessels, or organs, that sepa- 



Utero-gestation, the term of pregnancy. 

V 
Vaccine, cow-pox. [panion. 

Vade-mecum, a text book, pocket com- 
Vesication. blistering. 
Viscera, the bowels. 






INDEX. 



Antimony, may be a poison 546 Blood-letting may be practised 



Anatomy, a sketch of 373 

Acids, concentrated, may be poi- 
sons 535 

Antidotes for same 536* 

Alkalis, fixed, may be poisons. .538 

antidotes for 539 

Alcohol a poison 539 

Ammonia and its salts may poison ; j 

its antidotes 540; 

Arsenic a poison 542; 

how to be treated 544 

Antimony, tartarized, useful to 

stop drunkenness 273 j 

Amenorrhcea; treatment of 475 ■ 

Apparent Death from charcoal, 563 

hydrogen gas 564 

drowning 565 

strangling or hang- 
ing 567 

stroke of lightning . 568 

too great cold 568 

in new born infants, 569 

Apoplectic Fit 577 

Blood-letting, an important re- 
medy 81 

if very decisive, what follows . . 83 
how it affects the heart and 

blood vessels 85 

different opinions as to the man- 
ner how blood-letting acts in 

the removal of disease 

gives a shoek to the system . . . 
necessary in the forming state 

of fever 88 

it can strangle fever in its form- 
ing state 89 

often necessary in obstinate con- 
stipation 90 

in morbid perspiration 91 

it prevents what was called pu- 
trid fever 92 



86 

87 i 



in hot weather 93 

often necessary when the pa- 
tient feels weak 94 

may be necessary for very deli- 
cate patients 94 

may be necessary for infants 
and young children 95 

necessary for persons advanced 
in years 95 

often necessary in time of men- 
struation 96 

when necessary in pregnancy. 96 

when blood-letting is necessary, 
even the vapor bath will not 
produce a comfortable sweat 
till the patient shall have been 
bled 90 

may be necessary in petechial 
fever 98 

preferable to all other depleting 
remedies 101 

preferable to vomits in many 
cases 101 

to cathartics 102 

sometimes to sweating 103 

often preferable to abstemious 
diet or total abstinence 104 

by far the most delicate and a- 
greeable mode of evacuating 
the system 104 

in recent cases, bleed, on the 
rise of fever 113 

in neglected cases, let the fever 
be fairly up 113 

considerations forbidding its use 128 

often improper in congestive fe- 
ver .-.128 

in malignant fever after the third 
day 129 

needs circumspection in inter- 
mittent fever 129 



588 



INDEX. 



Blood-letting commonly forbid- 
den when the pulse is weak 
and frequent 129 

habitual drunkards must be bled 
with great caution 130 

improper after inflammation has 
ended in suppuration 130 

forbidden in pneumonia, after 
free expectoration 130 

wrong to bleed children when 
asleep 131 

not always necessary when the 
blood is buffy 131 

not always necessary because 
the pulse is tense 131 

often necessary in pregnancy . . 133 

also in time of, and after partu- 
rition 135 

also about the time menstrua- 
tion ceases 137 

a great general remedy 138 

appearances of the blood, when 
set to cool 140 

the patient may seem worse af- 
ter a first, and still need a re- 
petition 145 

if used too sparingly in autum- 



Cathartics, sometimes correct 

debility 289 

also heat of the skin 291 

particularly in exanthematous 

feversjscarlatina, simplex,etc. 292 
may be made to increase the ef- 
fect of diuretics 257 

useful in dropsy 285 

erysipelas and dysentery 292 

useful in gout and rheumatism . 297 

hydrocephalus internus 299 

hypochondriasis 301 

regard to be had to climate 220 

precaution in respect to climate 222 
mind, state of, to be regarded. .223 

useful in hysteria 302 

in St Vitus' dance 303 

in marasmus 304 

Child-Bed Fever 477 

treatment of 479 

Choking from any substance in 
the gullet 568 

Cholera Morbus, treatment of. 447 

Cholera Infantum, treatment of 486 

Chronic Hydrocephalus, treat- 
ment of 474 

Colic, treatment of 449 



nal fevers, it may disappoint. 146 Cold and damp weather, how they 



its weakening power its chief 

excellence 146 

if well timed, has no tendency 

to produce dropsy 147 

how much blood in a person of 

ordinary stature 150 

blood is rapidly regenerated . . . 152 
the quantity may be taken at one 

bleeding 152 

the pulse the dial-plate, or sur- 



produce disease 55 

variously modified by circum- 
stances 56 

Costiveness, often consequent 
on deficient excitement of the 
skin, and a dilated state of 

the portal vein 305 

Colic of Infants, treatment of. 486 

Copper a poison 544 

Croup 408 



est guide 154 Cuts and Wounds 573 

Blood, the circulation of 378 Debility, direct 47 

Burns or Scalds, of small extent 57 lj indirect 46 

when deep 571 Diarrhoea, treatment of 442 

when extensive 572 Diaphoretics, the manner how 

Bronchitis, acute, treatment of. 3! >8 they act 316 

chronic, treatment of 404 how antimony acts as a diapho- 

Bones out of joint, or dislocated. 579 retic 320 

Broken Bones 575 : different kinds and degree of. . . 320 



Bruises 574 

Cantharides a poison 551 

Capillaries, remarks on 394 

Cathartics 282 

how they operate 284 

they relieve pain in the head 
and thoracic viscera 288| 



farther remarks on 334 

the best and most powerful is 

dry heat 336 

none* so perfectly under control 

as heat 338 

different states of the system. .308 
require different management . .308 



INDEX. 



589 



Diaphoretics, diseased condi- 
tion of the viscera hinders the 

operation of 310 

circumstances which exhibit the 

most perfect diaphoresis 312 

an interesting case — great mis- 
chief done through want of 

well-timed reaction 314 

Disease, the cause of 212 

the French Doctor's case 213 

manner of entering sick room. .214 
necessity of ascertaining the af- 



Emetics in hcemopthysis 269 

in dysentery 271 

in mania a potu 272 

hypochondriac patients 273 

in child-bed mania 273 

in hysteria 274 

in asthma; in hooping cough. .274 

in apoplexy ; epilepsy 275 

in dyspepsia 27G 

in dropsy; diabetes 278 

in hernia humoralis ; jaundice . ,27& 

Enteritis : treatment of. . .439, 440 



fected organ 215 Epileptic Fits . . . c 577 



critical days 217 

danger of sweating by stimula- 
ting drinks 218 

any routine or system of set 

practice absurd 219 

when complicated, how treated, 247 
of long standing, so emaciates 
the skin, that heat is neces- 
sary for its correction 339 

Dropsy of the Brain ... .467 

treatment of 468 

Dysentery 444 

treatment of 445 

Dysmenorrhea, treatment of. . .470 

Dyspepsia, treatment of 451 

Eating to excess injurious to the 

condition of the blood ! 61 

Emetics 254 

Darwin's speculations on the 

subject 254 

Doctor Eberle's views 255 

a plain statement of the circum- 
stances as they occur in the 

act of vomiting . 256 

endermic practice ; note 243'' 

constitutional effects 257 1 

hcemorrhagic reaction 258 

jaundice sometimes induced by 

vomiting . 259j 

sometimes useful in dropsies. ..260l 

in diseases of the brain 260 

in almost all fevers .260 

in eruptive fevers 26J 

Smith's cases in a hospital of 

London . . . .262 

in some cases of erysipelas. . ..263 
in croup .264 



Epispastics 362 

Dr. Eberle's opinion concerning 363 

the author's views 364 

Dr. Armstrong's- erroneous .... 367 
useful in rheumatism and in dys- 
entery 368 

in erysipelas .369 

in bleeding at the nose and 

spasmodic affections ... 369 

Erysipelas, or St. Anthony's fire, 424 

treatment of 425 

Excitement, defined 44 

of the skin, the proper defence 
against cold nights, wet wea- 
ther, &c . 59 

a full excitement of, necessary 
to the perfection of the blood, 61 
Eyes, insects, sand, &c. in them. 570 

Fainting Fit 576- 

Fever, how generated 58 

intermittent, its periodicity ex- 
plained -.'. 70 

Cullen's theory, a sketch of. . . 71 

Brown's do 71 

Dr. Stokes' do; Clanny's do. .72, 73 

Dr. Clutterbuck's do 7a 

Broussais' do 74 

the different theories have led 

to difference in practice 75 

Dr. Southwood Smith's very val- 
uable 76- 

the author's summary review of 

the subject 80 

cases of fever considered 381 

intermittent, treatment of 385 

congestive do 385 

inflammatory do; catarrh do. ..391 



in pneumonia typhoidea 265 Frost Bite. .569 

in bilious pleurisy 265 Fits, convulsive ; hysteric 576 

acute inflammation of the eyes .266; epileptic ; apoplectic 577 

in rheumatism 266 Gangrene of the Mouth 497 

in gout 268 j treatment of 498 



590 INDEX. 

Gastritis ; treatment of. . .437, 438 Lymphatics 377 

Gestation, blood -letting often Lead, a dangerous poison 552 

necessary in 97 Materia Medica 227 

Glass, pounded, may do mischief, 55 1 medicinal substances absorbed, 231 

Gold, &c. may be poisons 549 first impression made on the sto- 

Gout.. 461 mach 231 

Heat, animal, how generated. . . 49 applied to the skin by friction. .234 
artificial, useful, often necessa- condition of the system after the 

ry, in cases of debility, whe- operation of medicines 235 

ther direct or indirect 49 medicaments, power & value of, 236 

why oppressively felt on a sum- medicaments, each makes its 

mer's evening, after a hot day, 50 own peculiar impression . . . .237 

why oppressively felt after great | but there is no specific 238 

loss of blood 50 Note by Dr. Snyder 240 

personal experiment, showing Measles; treatment of 430,431 

its action on the skin 50 Menses, cessation of 473 

external, opinions respecting its Menstruation, difficult . . .470 

application, erroneous 317 treatment of 470 

the application of, will detect Medicaments, surfaces to which 

the necessity of blood-letting they may be applied 241 

in some doubtful cases 325 to the skin 243 

in some cases useful, when ap- may act like issues 244 

plied very moderately 326 produce changes which are dif- 

Head, settled pain in 455 ficult to be understood 245 

Headache; treatment of ... 453, 454 each article seems to produce 

Hcemopthysis 462 its own peculiar effect 249 

treatment of the first variety . . .462 the system must be prepared, in 

second variety of 463 order to produce any special 

treatment of second variety 464 intention 250 

Hemorhoids ; treatment of, 456, 457 Milk* Leg ; treatment of 482 

Henbane a poison 457 Menorrhagia; treatment of 471 

Hooping Cough 412 Mucous Lining of the Bowels, 

its nature, seat, and treatment. 414 inflammation of, 439 

Hydrocephalus 467 Mumps, 436 

treatment of 468 Mushrooms, some are poisonous, 557 

Hydrophobia 561 Narcotic Poisons, how they act, 555 

Immoderate Flow of Menses, 47i Night-shade, a poison 559 

treatment of 471 Nux Vomica, a poison 558 

Incontinence of Urine 485 Opium, disguised, may poison, 556 

treatment of 485 Organic Disease, if neglected, 

Inflammation of the Larynx, 407 what mischiefs may follow, 247 

of the stomach 437 when more than one organ, is 

treatment of 433 diseased, what is to be done, 252 

of the eye; treatment of. .465. 466 Painful Menstruation; treat- 

Intention, Medical, what meant merit of, 470 

by it 171 Peritonitis, treatment of, 439 

of the humorist; mechanicians, 171 Phlegmasia alba dolens ; treat- 

of Cullen ; of Brown 172, 173 ment of, 482 

of Rush ; of Chapman 173, 174 Phosphorus, a poison; treatm't of, 551 

should have reference to the Piles ; treatment of, 456 

causes, nature, and seats of 'Pills, why so popular in Europe 

diseases 182 and the United States, 306 

Invalid Epicures, why they visit Pleurisy ; and treatment of, . .420-1 

medicinal springs 306 Pleurodynia, 421 

Jaundice ; treatment of 453 Portal Vessels, 379 



INDEX. 



591 



Pdlmonitis, with circumstances 
under which it commonly occurs,62 
symptoms when it commences,. 63 
remarks on the chill and shiver- 
ing which attends it, 64 

how it differs from a case of ma- 
lignant fever, 66 

its symptoms like those of inter- 
mittent fever, 68 

marks of distinction between it 
and a paroxysm of intermittent,69 
Pneumonia, inflammation of the 
lungs, and treatment of,. .416-17 

a corded pulse, 419 

Pulse as a guide in blood-letting, 105 
a full and vigorous, Dr. Rush's 

synochus-fortis pulse, 105 

full, frequent and tense, 108 

a cord-like pulse, 109 

a full, frequent and jerking, ... 114 
a small, frequent, but tense,. . .115 
a cord-like, extensively defined,116 

a tense, quick pulse, 119 

very frequent, without tension, 1 19 
a soft, without frequency or ful- 
ness, and yet alarming, .... 120 

difficult states of, • • • • 121 

rules for feeling, 123 

Recuperative powers, 164 

Rheumatism, a brief notice of,. .116 
inflammatory, treatment of,. 458-60 

chronic, 461 

Roseola, nettle rash, treatm't of,422-3 
Retention of urine, treatm't of, 484 

Saltpetre, may poison, 549 

Scarlet fever, treatm't of, 426-28 
Seasons, changes to be regarded, 224 
Sensorial influence is accumu- 
lated by the agency of cold 

and fear, 47 

Sensorial or nervous power con- 
curs with vitality in the pro- 
duction of sensation, 42 

so also in maintaining the func- 
tions of all the organs essen- 
tial to life ; it may exist in a- 



Skin, may be too long in a condi- 
tion of atony, 322 

when subject to the agency of 
heat, its whole surface should 
be brought at once under its 

influence, 324 

if naked, can bear dry heat at a 
temperature which would 

cook a beef-stake, 324 

Silner, may be a poison, 549 

Small pox, 434 

Snake bite, &c 560 

Spraines, 674 

Suppression of URiNE,treatm'tof,484 
Stimuli, abstraction of, is followed 

by a reduction of excitement, 47 
Sweating, spontaneous, some- 
times requires blood-letting, 97 

Summer Sickness, 489 

Tabes mesenterica, treatment, 495 
Tainted meats, fish, &c. poison- 
ous, ••...560 

Therapeutics defined, 159 

in regard of age, 185 

of infants, children and youthful 

patients, 186 

of old age, 188 

Dr. Snyder's note, 189 

temperament, sanguinous, .... 190 

" nervous, 190 

" lymphatic, 193 

" organic, 194 

modified by the general tempe't, 195 
peculir effects of nervous " 196 

strength and debility, 200 

direct debility, 202 

debility from residences in cold 

and damp places, 203 

indirect debility should be met 

by depletion, 206 

most cases of chronic affections 

need to be treated by depletion207 
remarks as to trades, habits, &C.208 

in respect of clothing, 206 

particular fancies or antipathies,210 
particular appetites, 210 



bundance, or may be deficient, 43 Vapor bath, how used when sick- 



Skin, excoriation or abrasion of, . 573 

susceptible of alternate suspen- 
sion & reaction of excitement,309 

the abdominal viscera prepared 
to correspond to it, 310 

when the correspondence spon- 
taneously equable, .... 311 

when this balance lost, conges- 
tion to be apprehended, , . . .312 



ness is threatened, 327 

how in the commencement of 

pleurisy, 328 

in inflammatory rheumatism, . . 329 
in dysentery and cholera morbus331 

in bilious colic, 332 

a cordial remedy, 341 

it will correct predisposition to 

fever, 342 



f r 

592 INDEX. » 

— T ^ 

Vapor bath, it counteracts a ten- -Vapor bath in cases of typhoid 

dency to local determination, 343 pneumonia, 35? 

a frame described for supporting in rheumatic gout, 359 

the bed clothes when used, .343 snake bite, 361 

the patient must be stripped of Vegetable poiso>-s,how they act 554 

all his clothing, 344 Vitality defined, 41 

a number of cases stated in its modifications in respect to 

which it is useful, 347 structures and functions,. ... 4'2 

used in fever, measles, &c 553 of the capillaries of the skin sus- 

in a case of croup, 354 tained by the circulation. . . . 33? 

in a case of bowel complaint: Womex, remarks respecting them,197 

another of head-ache, 355 YVou>T)s and cuts, 573 

in a case of cramp colic. 35G Zoc, as a poison, 54S 

in a case of dysentery, 357 



ERRATA. 

Page 29, fourth line from top, for " dismenorrhagia," read, dismenorrhcea. 

Page 64, seventeenth line, after the word arteries there ought to be a 
comma, (.). 

Page 105, eighth line from the top, for u full and vigorous," read, full, fre- 
quent and vigorous. 

Page 193, nine lines from bottom, for " lymphatic system/' read, lym- 
phatic temperament. 



